MEDICARE: B AND L BEARDEN INC

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	3336C0003X	Community/Retail Pharmacy	007445	GA

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

General Provider Information

NPI Number	:	1225101959
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	B AND L BEARDEN INC

Provider Business Mailing Address
First Line	:	5304 THOMPSON BRIDGE RD
Second Line	:
City	:	MURRAYVILLE
State	:	GA
Zip	:	30564-1941
Country	:	US
Telephone Number	:	770-534-2245
Fax Number	:	770-534-2093

Provider Business Practice Location Address
First Line	:	5304 THOMPSON BRIDGE RD
Second Line	:
City	:	MURRAYVILLE
State	:	GA
Zip	:	30564-1941
Country	:	US
Telephone Number	:	770-534-2245
Fax Number	:	770-534-2093

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MATTHEW CHACE VAUGHN
Credential	:
Telephone Number	:	770-534-2245

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	01/23/2026

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