Provider Demographics
NPI:1841370228
Name:BECK, COREY ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:COREY
Middle Name:ALLEN
Last Name:BECK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:315 W PONCE DE LEON AVE STE 880
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2479
Mailing Address - Country:US
Mailing Address - Phone:404-824-1755
Mailing Address - Fax:404-370-1324
Practice Address - Street 1:315 W PONCE DE LEON AVE STE 880
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2479
Practice Address - Country:US
Practice Address - Phone:404-824-1755
Practice Address - Fax:404-370-1324
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0581452084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA058145OtherGA LICENSE #