Provider Demographics
NPI:1053303248
Name:BECKHAM, MICHAEL THOMAS (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:THOMAS
Last Name:BECKHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5651 FRIST BLVD STE 701
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2061
Mailing Address - Country:US
Mailing Address - Phone:615-964-7990
Mailing Address - Fax:615-649-8079
Practice Address - Street 1:5651 FRIST BLVD STE 701
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2061
Practice Address - Country:US
Practice Address - Phone:615-964-7990
Practice Address - Fax:615-649-8079
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN24187207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3381621Medicaid
TN3381621Medicaid