MEDICARE: MR. CHARLES WILLIAM BERING MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	120	GA

General Provider Information

NPI Number	:	1922009430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES WILLIAM BERING MS

Provider Business Mailing Address
First Line	:	925 N POINT PKWY
Second Line	:	STE. 130
City	:	ALPHARETTA
State	:	GA
Zip	:	30005-5210
Country	:	US
Telephone Number	:	678-206-2589
Fax Number	:	678-261-1713

Provider Business Practice Location Address
First Line	:	81 NORTHSIDE DAWSON DR
Second Line	:	STE. 203
City	:	DAWSONVILLE
State	:	GA
Zip	:	30534-7166
Country	:	US
Telephone Number	:	706-265-6010
Fax Number	:	706-265-6009

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	02/09/2017

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