1366498594 NPI number — DR. CHERYL E. MCRAE-BERGERON D.N.P. CRNA

Table of content: DR. CHERYL E. MCRAE-BERGERON D.N.P. CRNA (NPI 1366498594)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366498594 NPI number — DR. CHERYL E. MCRAE-BERGERON D.N.P. CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCRAE-BERGERON
Provider First Name:
CHERYL
Provider Middle Name:
E.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.N.P. CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366498594
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/01/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
547 RIVERBEND RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLAIRSVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30512-5971
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-835-6166
Provider Business Mailing Address Fax Number:
706-781-6949

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
547 RIVERBEND RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLAIRSVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30512-5971
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-835-6166
Provider Business Practice Location Address Fax Number:
706-781-6949
Provider Enumeration Date:
05/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  RN035630 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1104009539 . This is a "COMPANY NPI" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1336498594 . This is a "PERSONAL NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 800341 . This is a "NORTH CAROLINA MEDICAID - COMPANY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8052438 . This is a "NORTH CAROLINA MEDICAID - INDIVIDUAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 43ZCCCS . This is a "PERSONAL PTAN" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 920479139A . This is a "GA MEDICAID PAYEE PROVIDER NUMBER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: GRP6628 . This is a "PTAN CHERYL E MCRAE-BERGERON, PC" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 6391 . This is a "MEDICAID PIN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com