Provider Demographics
NPI:1699781112
Name:BECKETT, THOMAS JOHNSON (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOHNSON
Last Name:BECKETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 HOLIDAY HILLS DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-3517
Mailing Address - Country:US
Mailing Address - Phone:910-465-2788
Mailing Address - Fax:
Practice Address - Street 1:5410 MARYLAND WAY
Practice Address - Street 2:SUITE 300
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5064
Practice Address - Country:US
Practice Address - Phone:615-371-4442
Practice Address - Fax:615-810-8952
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9501174207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891036UMedicaid
NCG53118Medicare UPIN
NC891036UMedicaid