| Organization Name: | BEACON PEDIATRICS |
| NPI Number: | 1043495963 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KITTY CHEATHAM (OFFICE MANAGER) |
| Mailing Address: | 801 Beacon St Waycross |
| State: | GA US |
| Postal Code: | 315017109 |
| Phone Number: | 9122852440 |
| Fax Number: | 9122870197 |
| NPI Enumeration Date: | 01/09/2008 |
| NPI Last Update Date: | 07/31/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 045745 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |