Provider Demographics
NPI:1861556847
Name:BECK, PAUL (PA)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:BECK
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:771 OLD NORCROSS RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-4386
Mailing Address - Country:US
Mailing Address - Phone:770-925-1515
Mailing Address - Fax:770-925-0289
Practice Address - Street 1:771 OLD NORCROSS RD
Practice Address - Street 2:SUITE 310
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4386
Practice Address - Country:US
Practice Address - Phone:770-925-1515
Practice Address - Fax:770-925-0289
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2010-03-21
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Provider Licenses
StateLicense IDTaxonomies
GA03146363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA03146OtherLICENSE