Healthcare Provider Details

I. General information

NPI: 1417941402
Provider Name (Legal Business Name): MICHELLE WILKINS BECKHAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 DODD ST
SPRING HOPE NC
27882-9348
US

IV. Provider business mailing address

PO BOX 7200
ROCKY MOUNT NC
27804-0200
US

V. Phone/Fax

Practice location:
  • Phone: 252-478-5412
  • Fax: 252-937-3100
Mailing address:
  • Phone: 252-937-0200
  • Fax: 252-451-0056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9901109
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2075316
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerUNITED HEALTH CARE
# 2
Identifier80170387
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerRAILROAD MEDICARE
# 3
Identifier9953298
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerCIGNA HEALTHCARE
# 4
Identifier128VG
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerBCBSNC
# 5
Identifier89128VG
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 6
IdentifierA7754
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerMEDCOST
# 7
Identifier6263983
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerAETNA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: