Individual
DWIGHT BEARDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
567 ARLINGTON PL, MACON, GA 31201-1704
(478) 745-9206
(478) 738-0758
Mailing address
PO BOX 4047, MACON, GA 31208-4047
(478) 745-9206
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
028247
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
260010573
RAIL ROAD MEDICARE #
GA
Enumeration date
11/16/2006
Last updated
11/30/2007
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