Provider Demographics
NPI:1427046994
Name:BEDGOOD, RAYMOND A (MD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:A
Last Name:BEDGOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 HIGHLAND PARK LOOP
Mailing Address - Street 2:
Mailing Address - City:PINE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:31822-2586
Mailing Address - Country:US
Mailing Address - Phone:706-483-2333
Mailing Address - Fax:
Practice Address - Street 1:404 HIGHLAND PARK LOOP
Practice Address - Street 2:
Practice Address - City:PINE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:31822-2586
Practice Address - Country:US
Practice Address - Phone:706-483-2333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA37955207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000584779AMedicaid
GA000584779AMedicaid
08BDGNQMedicare ID - Type Unspecified