Provider Demographics
NPI:1104009539
Name:CHERYL MCRAE-BERGERON, PC
Entity type:Organization
Organization Name:CHERYL MCRAE-BERGERON, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:MCRAE-BERGERON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA, ND
Authorized Official - Phone:706-835-6166
Mailing Address - Street 1:547 RIVERBEND RD
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512-5971
Mailing Address - Country:US
Mailing Address - Phone:706-835-6166
Mailing Address - Fax:706-781-6949
Practice Address - Street 1:547 RIVERBEND RD
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-5971
Practice Address - Country:US
Practice Address - Phone:706-835-6166
Practice Address - Fax:706-781-6949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN035630367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA43ZCCCSOtherINDIVIDUAL UPIN
GA000550965GOtherGA-MEDICAID PROVIDER #
GA50BBJGSOtherBUSINESS UPIN
NC8052438OtherMA-NC
GAGRP6628OtherMEDICARE GROUP NUMBER
1104009539OtherNPI # FOR CHERYL E. MCRAE-BERGERON, PC
GA1366498594OtherNPI # INDIVIDUAL: CHERYL E. MCRAE-BERGERON
NC8000341OtherMEDICAID-NC-GROUP
GA43ZCCCSOtherINDIVIDUAL UPIN