Provider Demographics
NPI:1578514980
Name:BECTON, JAMES LOUIS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LOUIS
Last Name:BECTON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:P.O BOX 1758
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3089
Mailing Address - Country:US
Mailing Address - Phone:706-854-2500
Mailing Address - Fax:706-854-2559
Practice Address - Street 1:1303 D'ANTIGNAC ST.
Practice Address - Street 2:SUITE 2600
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2796
Practice Address - Country:US
Practice Address - Phone:706-854-2500
Practice Address - Fax:706-854-2559
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA033932208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA271226705BMedicaid
GA000070155DMedicaid