Theadonelly Beckwith
Individual provider Active NPI Registered Nurse · Ft. Stewart, GA
NPI 1265834451 · NPPES record last updated Sep 19, 2014
Key facts
- NPI
- 1265834451
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 202055 (GA)
- Practice address
- 1061 Harmon Ave
Ft. Stewart, GA 31314 - Phone
- (912) 435-6008
- NPI assigned
- Sep 19, 2014
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 202055 | GA | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 202055 | GA | Yes |
Addresses
Primary practice location
1061 Harmon Ave
Ft. Stewart, GA 31314
Mailing address
165 Dove Drake Drive
Richmond Hill, GA 31324
Other providers in Ft. Stewart, GA
- Tonya Bean
- Alexia Beauregard
- Katie Lynn Beauregard
- Cara Moore Beavert
- Kelcie May Beck
- Briana Elizabeth Beeghly
- Dawn Elizabeth Belden
- Slava M Belenkiy
- Adrian Michelle Bell
- Catina Bell
All providers in Ft. Stewart, GA · Registered Nurse in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 19, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.