Bergstrom, Charles A
Bergstrom, Charles A is an individual health care provider with primary practice located at 108 North Park Dr. , Fayetteville GA 30214. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Family Medicine is his primary health care specialty. Bergstrom, Charles A can be contacted via phone (770) 461-3466.Contact Information
Primary practice address
108 North Park Dr.
Fayetteville GA 30214
Phone: (770) 461-3466
Fax: (770) 461-3884
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | 033030 | Georgia |
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 033030 | Georgia |
Profile Details
| NPI number | 1104886662 |
|---|---|
| LBN Legal business name | Bergstrom, Charles A |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 27th, 2006 |
| Last updated | Dec 30th, 2021 - 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1104886662 | NPPES |
| Georgia | Other | 1104886662 | NPI |
| Georgia | Other | 52030615 | NPI |
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