1396532966 NPI number — BECK PATTERSON MAXWELL CPHT

Table of content: BECK PATTERSON MAXWELL CPHT (NPI 1396532966)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396532966 NPI number — BECK PATTERSON MAXWELL CPHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAXWELL
Provider First Name:
BECK
Provider Middle Name:
PATTERSON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CPHT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MAXWELL
Provider Other First Name:
AMANDA
Provider Other Middle Name:
SUE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1396532966
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
433 ALLGOOD RD NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30060-1207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
470-215-1034
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
113 LINCOLN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODSTOCK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30188-7800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-694-7203
Provider Business Practice Location Address Fax Number:
770-694-7194
Provider Enumeration Date:
04/24/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183700000X , with the licence number:  PHTC063506 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30218639 . This is a "PHARMACY TECHNICIAN CERTIFICATION BOARD" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: PHTC063506 . This is a "GEORGIA BOARD OF PHARMACY" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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