Regina Alia Beacham, FNP-C
Individual provider Active NPI Family Nurse Practitioner · Blakely, GA
NPI 1659129393 · NPPES record last updated May 8, 2024
Key facts
- NPI
- 1659129393
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- RN24730 (GA)
- Practice address
- 12 E Carrie CT
Blakely, GA 39823-2824 - Phone
- (229) 308-1473
- NPI assigned
- May 8, 2024
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Christopher Dennis MD PLLC
Practice addresses (Care Compare)
11340 Lakefield Dr
Suite 200
Johns Creek, GA 30097-2456
Phone (888) 515-3834
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240903000329 | GA | Practitioner - Nurse Practitioner | 5496294688 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN24730 | GA | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Christopher Dennis MD PLLC | Single Specialty | Current |
Accepting new patients |
| Theoria Medical | Single Specialty | Current |
Accepting new patients |
Locations
1155 W College St
Bainbridge, GA 39819
Phone (229) 243-0931
1420 Milstead Rd NE
Conyers, GA 30012
Phone (770) 483-3902
101 Hartford Rd W
Fort Gaines, GA 39851
Phone (229) 768-2521
11340 Lakefield Dr
Ste 200
Johns Creek, GA 30097
Phone (678) 407-2159
7300 Lester Rd
Union City, GA 30291
Phone (770) 703-2604
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner |
363LF0000X | RN24730 | GA | Yes |
Addresses
Primary practice location
12 E Carrie CT
Blakely, GA 39823-2824
Mailing address
12 E Carrie CT
Blakely, GA 39823-2824
Phone (229) 308-1473
Other providers in Blakely, GA
- Aiyanna, LLC
- Albany Area Community Service Board
- Albany Area CSB
- Laura Shannon Alexander
- Vincent B. Barker
- Blakely Pharmacy LLC
- Christina Marie Bridges
- Brooks Dental Associates
- Brooks Dental Associates, Inc
- Charles Paschal Brooks Jr.
All providers in Blakely, GA · Family Nurse Practitioner in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 8, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.