Provider Demographics
NPI:1770672982
Name:BEACH, PAUL KEVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:KEVIN
Last Name:BEACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 STARLING STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4267
Mailing Address - Country:US
Mailing Address - Phone:912-265-5125
Mailing Address - Fax:912-261-0907
Practice Address - Street 1:2500 STARLING STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4267
Practice Address - Country:US
Practice Address - Phone:912-265-5125
Practice Address - Fax:912-261-0907
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA636292086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0489056OtherAETNA
SCP00067751OtherRR MEDICARE
GA707667089AMedicaid
SC236989Medicaid
SC0489056OtherAETNA
SC0489056OtherAETNA
SCH857061841Medicare ID - Type Unspecified