Provider Demographics
NPI:1811945447
Name:BEARDEN, GREGORY LEE (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:LEE
Last Name:BEARDEN
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:PO BOX 11407
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35202-1407
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:833 PRINCETON AVE SW STE 200B
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-1302
Practice Address - Country:US
Practice Address - Phone:205-776-8600
Practice Address - Fax:205-776-8603
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL25239208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529914040Medicaid
AL25239OtherSTATE LICENSE
AL529914040Medicaid