Provider Demographics
NPI:1578594057
Name:BEECHAM, ALLEN RANDLE (DO)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:RANDLE
Last Name:BEECHAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 VILLAGE PROFESSIONAL DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-8498
Mailing Address - Country:US
Mailing Address - Phone:678-661-4545
Mailing Address - Fax:
Practice Address - Street 1:2000 VILLAGE PROFESSIONAL DR
Practice Address - Street 2:SUITE 200
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-8498
Practice Address - Country:US
Practice Address - Phone:678-661-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025102207P00000X, 207Q00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000318447GMedicaid
GA93BFBTNMedicare ID - Type Unspecified
GA000318447GMedicaid