Provider Demographics
NPI:1811935414
Name:BECTON, ELIZABETH C (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:C
Last Name:BECTON
Suffix:
Gender:F
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 1758
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3089
Mailing Address - Country:US
Mailing Address - Phone:706-854-2500
Mailing Address - Fax:706-854-2559
Practice Address - Street 1:1303 D'ANTIGNAC ST.
Practice Address - Street 2:SUITE 2600
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2796
Practice Address - Country:US
Practice Address - Phone:706-854-2500
Practice Address - Fax:706-854-2559
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038178173000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000612026HMedicaid
GA000612026EMedicaid
GA000612026EMedicaid