MEDICARE: JAMES DEWITT BEARDEN III MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	5674	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	SCG0033365	OTHER	SC	MEDICARE PIN
5	P00692282	OTHER	SC	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0732330001	OTHER	SC	NATIONAL SUPPLIER CLEARIN
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447256730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES DEWITT BEARDEN III MD

Provider Business Mailing Address
First Line	:	PO BOX 743070
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-3070
Country	:	US
Telephone Number	:	864-560-4304
Fax Number	:	864-560-4413

Provider Business Practice Location Address
First Line	:	101 E WOOD ST
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29303-3040
Country	:	US
Telephone Number	:	864-560-7050
Fax Number	:	864-560-0800

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	02/01/2023

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