Provider Demographics
NPI:1952708984
Name:BECK, JEREMY (NP-C)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:BECK
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 MOORE ST
Mailing Address - Street 2:
Mailing Address - City:OMEGA
Mailing Address - State:GA
Mailing Address - Zip Code:31775-3075
Mailing Address - Country:US
Mailing Address - Phone:229-528-6500
Mailing Address - Fax:888-972-4023
Practice Address - Street 1:130 MOORE ST
Practice Address - Street 2:
Practice Address - City:OMEGA
Practice Address - State:GA
Practice Address - Zip Code:31775-3075
Practice Address - Country:US
Practice Address - Phone:229-528-6500
Practice Address - Fax:888-972-4023
Is Sole Proprietor?:No
Enumeration Date:2014-11-19
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN207208363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003153974AMedicaid