Provider Demographics
NPI:1215904065
Name:BECKNER, JAMES P (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:P
Last Name:BECKNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:999 EXECUTIVE PARK BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4632
Mailing Address - Country:US
Mailing Address - Phone:423-224-3250
Mailing Address - Fax:423-224-3258
Practice Address - Street 1:130 W RAVINE RD
Practice Address - Street 2:SUITE 3A
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3837
Practice Address - Country:US
Practice Address - Phone:423-224-3220
Practice Address - Fax:423-224-3233
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2012-07-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN35292207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010010128Medicaid
TN3864978Medicaid
TN103I162919Medicare PIN
TN3864978Medicare PIN
TN3864978Medicaid
VA010010128Medicaid