1760445852 NPI number — RONALD G BEEBE MD

Table of content: RONALD G BEEBE MD (NPI 1760445852)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760445852 NPI number — RONALD G BEEBE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEEBE
Provider First Name:
RONALD
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760445852
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
950 S ENOTA DR NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30501-2413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-536-0470
Provider Business Mailing Address Fax Number:
770-536-3031

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
950 S ENOTA DR NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-536-0470
Provider Business Practice Location Address Fax Number:
770-536-3031
Provider Enumeration Date:
04/10/2006

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: 207K00000X , with the licence number:  030006 , 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: 000353075L , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000353075N , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000353075J , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 52029274 . This is a "BCBS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000353075I , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000353075K , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00897212 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 0811620 . This is a "CIGNA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 584715 . This is a "WELLCARE OF GEORGIA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: D44835 . This is a "MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 01389421 . This is a "AMERIGROUP" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000353075M , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1246699 . This is a "COVENTRY" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 584715 . This is a "WELLCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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