Basic Information
Provider Information
NPI: 1003017526
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BECKFORD
FirstName: TANYA
MiddleName: DENISE
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1279 HIGHWAY 54 W
Address2: SUITE 220
City: FAYETTEVILLE
State: GA
PostalCode: 302144550
CountryCode: US
TelephoneNumber: 7709912200
FaxNumber: 7707168672
Practice Location
Address1: 1279 HIGHWAY 54 W
Address2: SUITE 220
City: FAYETTEVILLE
State: GA
PostalCode: 302144550
CountryCode: US
TelephoneNumber: 7709912200
FaxNumber: 7707168672
Other Information
ProviderEnumerationDate: 05/31/2007
LastUpdateDate: 06/06/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000X060703GAY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 
207VG0400X244284NYN Allopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology

No ID Information.


Home