Individual
DR. CHERYL E. MCRAE-BERGERON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.N.P. CRNA
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
—
1104009539
COMPANY NPI
GA
01
—
1336498594
PERSONAL NPI
—
01
—
43ZCCCS
PERSONAL PTAN
GA
01
—
6391
MEDICAID PIN
NC
01
—
800341
NORTH CAROLINA MEDICAID - COMPANY
—
01
—
8052438
NORTH CAROLINA MEDICAID - INDIVIDUAL
—
01
—
920479139A
GA MEDICAID PAYEE PROVIDER NUMBER
GA
01
—
GRP6628
PTAN CHERYL E MCRAE-BERGERON, PC
GA
Enumeration date
05/26/2006
Last updated
09/01/2014
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