Provider Demographics
NPI:1962564021
Name:BECKER, NADINE (MD)
Entity type:Individual
Prefix:
First Name:NADINE
Middle Name:
Last Name:BECKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 JOHNSON FERRY RD NE
Mailing Address - Street 2:STE 400
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-4771
Mailing Address - Country:US
Mailing Address - Phone:404-257-0170
Mailing Address - Fax:404-591-3146
Practice Address - Street 1:960 JOHNSON FERRY RD NE
Practice Address - Street 2:STE 400
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-4771
Practice Address - Country:US
Practice Address - Phone:404-257-0170
Practice Address - Fax:404-591-3146
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040311207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00677971AMedicaid
GA00677971HMedicaid
GA499239OtherBCSB
GA5746121OtherAETNA
GA00677971HMedicaid
GA00677971HMedicaid