Provider Demographics
NPI:1538212519
Name:BECKNER, JOHN WILLIAM JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILLIAM
Last Name:BECKNER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:79 HIGHWAY 286 UNIT B
Mailing Address - Street 2:
Mailing Address - City:ETON
Mailing Address - State:GA
Mailing Address - Zip Code:30705-6501
Mailing Address - Country:US
Mailing Address - Phone:706-280-5830
Mailing Address - Fax:
Practice Address - Street 1:79 HIGHWAY 286 UNIT B
Practice Address - Street 2:
Practice Address - City:ETON
Practice Address - State:GA
Practice Address - Zip Code:30705-6501
Practice Address - Country:US
Practice Address - Phone:706-971-3757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0616942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003104047GMedicaid
GAP01366679OtherRR MEDICARE
GA02036288OtherAMERIGROUP
GA983434OtherWELLCARE
GA202I264139Medicare PIN