Provider Demographics
NPI:1700874971
Name:BEEBE, LUCIUS COURTENAY SR (MD)
Entity Type:Individual
Prefix:
First Name:LUCIUS
Middle Name:COURTENAY
Last Name:BEEBE
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:L
Other - Middle Name:COURTENAY
Other - Last Name:BEEBE
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:EMORY UNIVERSITY HOSPITAL
Mailing Address - Street 2:1364 CLIFTON RD NE
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1059
Mailing Address - Country:US
Mailing Address - Phone:404-323-3116
Mailing Address - Fax:
Practice Address - Street 1:EMORY UNIVERSITY HOSPITAL
Practice Address - Street 2:1364 CLIFTON RD NE
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1059
Practice Address - Country:US
Practice Address - Phone:404-323-3116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1602208800000X
VA0101042459208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006001220Medicaid
VA049990OtherBCBS ANTHEM
340000163Medicare PIN
B06734Medicare UPIN
340005446Medicare PIN