Healthcare Provider Details

I. General information

NPI: 1396821856
Provider Name (Legal Business Name): GARY LOYAL BECKMAN CCP, LCP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4803 NEW AIRLINE RD
ARLINGTON TN
38002-9586
US

IV. Provider business mailing address

4803 NEW AIRLINE RD
ARLINGTON TN
38002-9586
US

V. Phone/Fax

Practice location:
  • Phone: 901-867-2815
  • Fax: 901-867-0569
Mailing address:
  • Phone: 901-867-4867
  • Fax: 901-867-0569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number00001
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: