Healthcare Provider Details

I. General information

NPI: 1215904065
Provider Name (Legal Business Name): JAMES P BECKNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 07/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 W RAVINE RD SUITE 3A
KINGSPORT TN
37660-3837
US

IV. Provider business mailing address

999 EXECUTIVE PARK BLVD SUITE 201
KINGSPORT TN
37660-4632
US

V. Phone/Fax

Practice location:
  • Phone: 423-224-3220
  • Fax: 423-224-3233
Mailing address:
  • Phone: 423-224-3250
  • Fax: 423-224-3258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35292
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: