Organization
CHERYL MCRAE-BERGERON, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHERYL ELAINE MCRAE-BERGERON CRNA, ND (OWNER/OPERATOR)
(706) 835-6166
Entity
Organization
Contact information
Practice address
547 RIVERBEND RD, BLAIRSVILLE, GA 30512-5971
(706) 835-6166
(706) 781-6949
Mailing address
547 RIVERBEND RD, BLAIRSVILLE, GA 30512-5971
(706) 835-6166
(706) 781-6949
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN035630
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000550965G
GA-MEDICAID PROVIDER #
GA
01
—
1104009539
NPI # FOR CHERYL E. MCRAE-BERGERON, PC
—
01
—
1366498594
NPI # INDIVIDUAL: CHERYL E. MCRAE-BERGERON
GA
01
—
43ZCCCS
INDIVIDUAL UPIN
GA
01
—
50BBJGS
BUSINESS UPIN
GA
01
—
8000341
MEDICAID-NC-GROUP
NC
01
—
8052438
MA-NC
NC
01
—
GRP6628
MEDICARE GROUP NUMBER
GA
Enumeration date
12/07/2007
Last updated
08/11/2014
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