Provider Demographics
NPI:1174564397
Name:BECKHAM, JAMES R (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:BECKHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1622 ANNE STOKES ROAD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701
Mailing Address - Country:US
Mailing Address - Phone:662-335-3700
Mailing Address - Fax:
Practice Address - Street 1:129 E STARLING ST
Practice Address - Street 2:SUITE C
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-4725
Practice Address - Country:US
Practice Address - Phone:662-725-1500
Practice Address - Fax:662-725-1515
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS09074207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00013803Medicaid
AR113408001Medicaid
LA1398608Medicaid
P00397655OtherRR MEDICARE
P00397655OtherRR MEDICARE
MS00013803Medicaid