Provider Demographics
NPI:1902913429
Name:BECK, ALLEN DALE (MD)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:DALE
Last Name:BECK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALLEN
Other - Middle Name:D
Other - Last Name:BECK MD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1365B CLIFTON RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1013
Mailing Address - Country:US
Mailing Address - Phone:404-778-5416
Mailing Address - Fax:404-778-4350
Practice Address - Street 1:1365-B CLIFTON RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1013
Practice Address - Country:US
Practice Address - Phone:404-778-5416
Practice Address - Fax:404-778-4350
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA33525207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00531792BMedicaid
GA18BDCPQMedicare ID - Type Unspecified
GAF51047Medicare UPIN