Healthcare Provider Details

I. General information

NPI: 1609829274
Provider Name (Legal Business Name): CAMERON MICHAEL BERGIN PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 KING AVENUE SUITE 150
ATHENS GA
30606
US

IV. Provider business mailing address

9990 DOUBLE R BLVD STE 200
RENO NV
89521-4833
US

V. Phone/Fax

Practice location:
  • Phone: 706-475-1870
  • Fax:
Mailing address:
  • Phone: 753-488-8007
  • Fax: 775-348-8818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA1847
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3116
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number10445
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: