Bagwell, Charles A

Bagwell, Charles A is an individual health care provider with primary practice located at 100 Doctors Dr Ste C , Douglas GA 31533-2211. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Bagwell, Charles A can be contacted via phone (912) 384-5832.

Contact Information

Primary practice address
100 Doctors Dr Ste C Douglas GA 31533-2211
Phone: (912) 384-5832
Fax: (912) 383-8279
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 050494 Georgia

Profile Details

NPI number 1366417479
LBN Legal business name Bagwell, Charles A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 22nd, 2006
Last updated Mar 7th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1366417479 NPPES
Georgia Other 11D1105865 CLIA ID - 17 JOHNSON ST
Georgia Other 341153 CLIA ID - 17 JOHNSON ST
Georgia MEDICAID 000919729B CLIA ID - 17 JOHNSON ST
Georgia MEDICAID 000919729C CLIA ID - 17 JOHNSON ST
Georgia Other 050494 CLIA ID - 17 JOHNSON ST
Georgia Other 050494 CLIA ID - 17 JOHNSON ST
Georgia Other 11D0265294 CLIA ID - 17 JOHNSON ST
Georgia Other PTAN P00473716 CLIA ID - 17 JOHNSON ST
Georgia Other 129049 CLIA ID - 17 JOHNSON ST
Georgia Other GROUP #DH1281 CLIA ID - 17 JOHNSON ST

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