Provider Demographics
NPI:1396863874
Name:BECKER, JOY (PA-C)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:BECKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 DALEROSE AVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3935
Mailing Address - Country:US
Mailing Address - Phone:404-428-1935
Mailing Address - Fax:
Practice Address - Street 1:1875 CENTURY BLVD NE STE 150
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-3323
Practice Address - Country:US
Practice Address - Phone:404-633-4595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10005174363A00000X
GA006127363A00000X
MT611363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q78362Medicare UPIN
8864675Medicare PIN