Provider Demographics
NPI:1972676690
Name:BEARDEN, LINDA P
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:P
Last Name:BEARDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 HUGH STOWERS RD
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-5334
Mailing Address - Country:US
Mailing Address - Phone:706-265-4664
Mailing Address - Fax:770-534-2093
Practice Address - Street 1:5304 THOMPSON BRIDGE RD
Practice Address - Street 2:
Practice Address - City:MURRAYVILLE
Practice Address - State:GA
Practice Address - Zip Code:30564-1941
Practice Address - Country:US
Practice Address - Phone:770-534-2245
Practice Address - Fax:770-534-2093
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA015488183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist