Provider Demographics
NPI:1518956242
Name:MINCEY, BETTY ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:BETTY
Middle Name:ANN
Last Name:MINCEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 PEACHTREE INDUSTRIAL BLVD STE 4203
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-4540
Mailing Address - Country:US
Mailing Address - Phone:770-831-3018
Mailing Address - Fax:770-831-3669
Practice Address - Street 1:1300 PEACHTREE INDUSTRIAL BLVD STE 4203
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024
Practice Address - Country:US
Practice Address - Phone:770-831-3018
Practice Address - Fax:770-831-3669
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-15
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA081899207R00000X
NC2014-02112207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCL563AMedicare PIN
NCNCL563AMedicare PIN
FL32738OtherBLUECROSS/BLUESHIELD
FLP00286169OtherRAILROAD MEDICARE