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Individual

DR. CHARLES A BERGSTROM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
108 NORTH PARK DR., FAYETTEVILLE, GA 30214
(770) 461-3466
(770) 461-3884
Mailing address
108 N PARK DR, FAYETTEVILLE, GA 30214-1645
(770) 461-3466
(770) 461-3884

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
033030
GA
207Q00000X
Family Medicine Physician
Primary
033030
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1104886662
NPI
GA
01
52030615
BCBS OF GA
GA
Enumeration date
03/27/2006
Last updated
12/30/2021
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