1700874971 NPI number — LUCIUS COURTENAY BEEBE SR. MD

Table of content: LUCIUS COURTENAY BEEBE SR. MD (NPI 1700874971)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700874971 NPI number — LUCIUS COURTENAY BEEBE SR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEEBE
Provider First Name:
LUCIUS
Provider Middle Name:
COURTENAY
Provider Name Prefix Text:
Provider Name Suffix Text:
SR.
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BEEBE
Provider Other First Name:
L
Provider Other Middle Name:
COURTENAY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
SR.
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1700874971
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
EMORY UNIVERSITY HOSPITAL
Provider Second Line Business Mailing Address:
1364 CLIFTON RD NE
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30322-1059
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-323-3116
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
EMORY UNIVERSITY HOSPITAL
Provider Second Line Business Practice Location Address:
1364 CLIFTON RD NE
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30322-1059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-323-3116
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/11/2005

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: 208800000X , with the licence number:  1602 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X , with the licence number: 0101042459 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 006001220 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 049990 . This is a "BCBS ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".