Active NPI
Molly Marie Bearden, LPN
- Licensed Practical Nurse
- Chatsworth, GA
National Provider Identifier
1104395300
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- LPN04532
- Practice address
- 1289 Gi Maddox Pkwy
Chatsworth, GA 30705-2069 - Phone
- (706) 971-3366
- NPI assigned
- Nov 16, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | LPN04532 | GA | Primary |
Addresses
Primary practice location
1289 Gi Maddox Pkwy
Chatsworth, GA 30705-2069
Mailing address
1289 Gi Maddox Pkwy
Chatsworth, GA 30705-2069
Phone (706) 971-3366
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 164W0000X | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPN04532 | GA | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1542326400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1542326400000",
"number": "1104395300",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1289 GI MADDOX PKWY",
"city": "CHATSWORTH",
"state": "GA",
"postal_code": "307052069",
"telephone_number": "706-971-3366"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1289 GI MADDOX PKWY",
"city": "CHATSWORTH",
"state": "GA",
"postal_code": "307052069",
"telephone_number": "706-971-3366"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEARDEN",
"first_name": "MOLLY",
"middle_name": "MARIE",
"credential": "LPN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-11-16",
"last_updated": "2018-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "GA",
"license": "LPN04532",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "164W0000X",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chatsworth, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.