Provider Demographics
NPI:1376528067
Name:BEECH, JOYCE WAGNER (PAC)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:WAGNER
Last Name:BEECH
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 PREMIER DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-8357
Mailing Address - Country:US
Mailing Address - Phone:336-802-2075
Mailing Address - Fax:336-802-2076
Practice Address - Street 1:4515 PREMIER DR
Practice Address - Street 2:SUITE 204
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-8357
Practice Address - Country:US
Practice Address - Phone:336-802-2075
Practice Address - Fax:336-802-2076
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC000100618363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
970025246Medicare PIN
NC2744270AMedicare PIN
P29476Medicare UPIN