MEDICARE: SUSAN ANNETTE BECKETT N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	RN152959 NP	GA

General Provider Information

NPI Number	:	1396799193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN ANNETTE BECKETT N.P.

Provider Business Mailing Address
First Line	:	5670 PEACHTREE DUNWOODY RD NE
Second Line	:	SUITE 1000
City	:	ATLANTA
State	:	GA
Zip	:	30342-1704
Country	:	US
Telephone Number	:	404-255-1930
Fax Number	:	404-459-8510

Provider Business Practice Location Address
First Line	:	314 STEWART ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98101-9810
Country	:	US
Telephone Number	:	206-347-1300
Fax Number	:	206-347-1275

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	04/07/2020

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