Provider Demographics
NPI:1629008040
Name:BEECHER, MARTHA D (NP)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:D
Last Name:BEECHER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2070
Mailing Address - Street 2:
Mailing Address - City:BAXLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31515-2070
Mailing Address - Country:US
Mailing Address - Phone:912-367-9841
Mailing Address - Fax:912-367-0436
Practice Address - Street 1:195 E TOLLISON ST
Practice Address - Street 2:
Practice Address - City:BAXLEY
Practice Address - State:GA
Practice Address - Zip Code:31513-0120
Practice Address - Country:US
Practice Address - Phone:912-367-0434
Practice Address - Fax:912-367-0436
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN124430163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000807419DMedicaid
GA000807419BMedicaid
GA000807419CMedicaid
GA50BBDCCMedicare ID - Type UnspecifiedTOOMBS HD
GAS89537Medicare UPIN
GA50BBDBLMedicare ID - Type UnspecifiedJEFF DAVIS HD
GA000807419BMedicaid