Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 00275 | GA |
NPI | 1255972840 |
---|---|
Provider Name | Chelsey Beckham |
First Address | Woodstock, GA 30189-5102 |
Second Address | Woodstock, GA 30188-2834 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2019 |
Last Update Date | 04/10/2019 |