Individual
DR. CHARLES A BAGWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 DOCTORS DR STE C, DOUGLAS, GA 31533-2211
(912) 384-5832
(912) 383-8279
Mailing address
1100 WARD STREET EXT W, DOUGLAS, GA 31533-1902
(912) 384-1477
(912) 384-1470
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
050494
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000919729B
—
GA
05
—
000919729C
—
GA
01
—
050494
GA LICENSE
GA
01
—
11D0265294
CLIA ID - 1309 OCILLA RD STE A
GA
01
—
11D1105865
CLIA ID - 17 JOHNSON ST
GA
01
—
129049
PEACHSTATE
GA
01
—
341153
WELLCARE OF GEORGIA
GA
01
—
GROUP #DH1281
RAILROAD MEDICARE - PALMETTO GBA
GA
01
—
PTAN P00473716
RAILROAD MEDICARE - PALMETTO GBA
GA
Enumeration date
02/22/2006
Last updated
03/07/2023
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