NPIMap

Individual provider Active NPI

Robert Wayne Bearden Jr., D.C.

  • Chiropractor
  • Bonaire, GA
National Provider Identifier
1508034919
Registry record updated Dec 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
4733 Issued in GA
Practice address
100 Stillwater Cir Ste C
Bonaire, GA 31005-3856
Phone
(478) 293-4883
Fax
(478) 293-4886
NPI assigned
Feb 19, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 4733 GA Primary

Addresses

Primary practice location

100 Stillwater Cir Ste C
Bonaire, GA 31005-3856

Mailing address

100 Stillwater Cir Ste C
Bonaire, GA 31005-3856
Phone (478) 293-4883

Other practice location 1

100 Stillwater Circle
Bonaire, GA 31005
Phone (478) 231-9605

Other practice location 2

100 Stillwater Cir Ste C
Bonaire, GA 31005-3856
Phone (478) 293-4883

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
4733GAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Bearden Chiropractic Center Chiropractor Past Accepting new patients
Bearden Chiropractic Center Chiropractor PastSince Apr 1, 2008 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1203379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606953600000",
    "number": "1508034919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 STILLWATER CIR STE C",
            "city": "BONAIRE",
            "state": "GA",
            "postal_code": "310053856",
            "telephone_number": "478-293-4883",
            "fax_number": "478-293-4886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 STILLWATER CIR STE C",
            "city": "BONAIRE",
            "state": "GA",
            "postal_code": "310053856",
            "telephone_number": "478-293-4883",
            "fax_number": "478-293-4886"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Stillwater Circle",
            "address_purpose": "LOCATION",
            "city": "Bonaire",
            "state": "GA",
            "postal_code": "31005",
            "country_code": "US",
            "telephone_number": "478-231-9605",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 Stillwater Cir Ste C",
            "address_purpose": "LOCATION",
            "city": "Bonaire",
            "state": "GA",
            "postal_code": "310053856",
            "country_code": "US",
            "telephone_number": "478-293-4883",
            "fax_number": "478-293-4886",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BEARDEN",
        "first_name": "ROBERT",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-02-19",
        "last_updated": "2020-12-03",
        "certification_date": "2020-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "4733",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bonaire, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.