Basic Information
Provider Information
NPI: 1912061318
EntityType: 2
ReplacementNPI:  
OrganizationName: BECKMAN
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1547 PARKWAY
Address2: SUITE 100
City: GREENWOOD
State: SC
PostalCode: 296464081
CountryCode: US
TelephoneNumber: 8642297120
FaxNumber:  
Practice Location
Address1: 45 W MAIN ST
Address2:  
City: WARE SHOALS
State: SC
PostalCode: 296921440
CountryCode: US
TelephoneNumber: 8644562711
FaxNumber: 8644564470
Other Information
ProviderEnumerationDate: 12/20/2006
LastUpdateDate: 08/22/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: SMITH
AuthorizedOfficialFirstName: BARBARA
AuthorizedOfficialMiddleName: ELIZABETH
AuthorizedOfficialTitleorPosition: MHP
AuthorizedOfficialTelephone: 8644562711
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
251S00000X  Y AgenciesCommunity/Behavioral Health 

ID Information
IDTypeStateIssuerDescription
42150405SC MEDICAID


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