Provider Demographics
NPI:1124135678
Name:BOMBERGER, CATHERINE J (MD)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:J
Last Name:BOMBERGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 HOSPITAL DR
Mailing Address - Street 2:BUILDING B SUITE 315
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-3895
Mailing Address - Country:US
Mailing Address - Phone:478-464-5000
Mailing Address - Fax:478-464-5094
Practice Address - Street 1:310 HOSPITAL DR
Practice Address - Street 2:BUILDING B SUITE 315
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-3895
Practice Address - Country:US
Practice Address - Phone:478-464-5000
Practice Address - Fax:478-464-5094
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA048188207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00875476AMedicaid
GA00875476AMedicaid
H15747Medicare UPIN