Healthcare Provider Details

I. General information

NPI: 1750449591
Provider Name (Legal Business Name): AUGUSTUS PITT BEAM III PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: PITT BEAM PH.D.

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1835 UNION AVE SUITE315
MEMPHIS TN
38104-3921
US

IV. Provider business mailing address

4133 HEDGE HILLS AVE
MEMPHIS TN
38117-1625
US

V. Phone/Fax

Practice location:
  • Phone: 901-726-1284
  • Fax: 901-726-4396
Mailing address:
  • Phone: 901-683-8614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberP-1204
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: