Provider Demographics
NPI:1639178064
Name:BEATTY, TIMOTHY B (DO)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:B
Last Name:BEATTY
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 1:4615 OLEANDER DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5741
Mailing Address - Country:US
Mailing Address - Phone:843-497-5929
Mailing Address - Fax:843-497-9940
Practice Address - Street 1:501 ROBERTSON BLVD
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-2787
Practice Address - Country:US
Practice Address - Phone:843-497-5929
Practice Address - Fax:843-497-9940
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC911207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC009118Medicaid
SCH374592986Medicare PIN
SCH374592987Medicare PIN
SC009118Medicaid
SCP00298434Medicare PIN
SCH374597070Medicare PIN
SCH37459Medicare UPIN
SCH374596103Medicare ID - Type Unspecified