Provider Demographics
NPI:1396532966
Name:MAXWELL, BECK PATTERSON (CPHT)
Entity type:Individual
Prefix:
First Name:BECK
Middle Name:PATTERSON
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:SUE
Other - Last Name:MAXWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:433 ALLGOOD RD NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1207
Mailing Address - Country:US
Mailing Address - Phone:470-215-1034
Mailing Address - Fax:
Practice Address - Street 1:113 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-7800
Practice Address - Country:US
Practice Address - Phone:770-694-7203
Practice Address - Fax:770-694-7194
Is Sole Proprietor?:No
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHTC063506183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA30218639OtherPHARMACY TECHNICIAN CERTIFICATION BOARD
GAPHTC063506OtherGEORGIA BOARD OF PHARMACY