Individual
DR. BROOK GOFF BEARDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4340 KINGS WAY, VALDOSTA, GA 31602-6921
(229) 333-9736
(229) 333-0225
Mailing address
PO BOX 370, FORTSON, GA 31808-0370
(706) 494-3008
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
56527
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
420420515A
—
GA
01
—
P00355787
RAILROAD MEDICARE
GA
Enumeration date
12/22/2006
Last updated
12/01/2020
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