Provider Demographics
NPI:1669689865
Name:BECKWORTH, WILLIAM JEREMY (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JEREMY
Last Name:BECKWORTH
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:PO BOX 1869
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-1869
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:828-650-8076
Practice Address - Street 1:50 HOSPITAL DR STE 2D
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-5251
Practice Address - Country:US
Practice Address - Phone:828-654-8546
Practice Address - Fax:828-650-8060
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0590422081P2900X
NC2022-02036208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA20772A001Medicare UPIN