Provider Demographics
NPI:1699855510
Name:BECKHAM, MARSHA D (OD)
Entity Type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:D
Last Name:BECKHAM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 HAWTHORNE AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2881
Mailing Address - Country:US
Mailing Address - Phone:706-543-3599
Mailing Address - Fax:706-543-8681
Practice Address - Street 1:270 HAWTHORNE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2881
Practice Address - Country:US
Practice Address - Phone:706-543-3599
Practice Address - Fax:706-543-8681
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000164540152W00000X
GAOPT002906152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO315306019Medicaid
MO315306019Medicaid
MOU83238Medicare UPIN