Provider Demographics
NPI:1639195084
Name:BECERRA, JOSUE (MD)
Entity Type:Individual
Prefix:
First Name:JOSUE
Middle Name:
Last Name:BECERRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6003 VETERANS PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-6284
Mailing Address - Country:US
Mailing Address - Phone:706-223-1933
Mailing Address - Fax:
Practice Address - Street 1:6003 VETERANS PKWY STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-6284
Practice Address - Country:US
Practice Address - Phone:706-223-1933
Practice Address - Fax:706-223-1934
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL263162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051555748OtherSPS - BCBS
AL051555750OtherEBHS - BCBS
AL051533945OtherTROY - BCBS
AL009992945Medicaid
AL051555749OtherOSC - BCBS
AL051533945OtherTROY - BCBS
AL051555749OtherOSC - BCBS
AL051555749Medicare ID - Type UnspecifiedOSC
AL009937587Medicare ID - Type UnspecifiedTROY
AL009992935Medicare ID - Type UnspecifiedEBHS
AL051555748OtherSPS - BCBS
AL051555750OtherEBHS - BCBS