Provider Demographics
NPI:1508034919
Name:BEARDEN, ROBERT WAYNE JR (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WAYNE
Last Name:BEARDEN
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 STILLWATER CIR STE C
Mailing Address - Street 2:
Mailing Address - City:BONAIRE
Mailing Address - State:GA
Mailing Address - Zip Code:31005-3856
Mailing Address - Country:US
Mailing Address - Phone:478-293-4883
Mailing Address - Fax:478-293-4886
Practice Address - Street 1:100 STILLWATER CIR STE C
Practice Address - Street 2:
Practice Address - City:BONAIRE
Practice Address - State:GA
Practice Address - Zip Code:31005-3856
Practice Address - Country:US
Practice Address - Phone:478-293-4883
Practice Address - Fax:478-293-4886
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4733111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor