Healthcare Provider Details

I. General information

NPI: 1558367193
Provider Name (Legal Business Name): CARL O BEDINGFIELD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2406 BELLEVUE RD BLDG. 10
DUBLIN GA
31021-2842
US

IV. Provider business mailing address

113 ROBERSON ST
DUBLIN GA
31021-2938
US

V. Phone/Fax

Practice location:
  • Phone: 478-272-2623
  • Fax: 478-272-9984
Mailing address:
  • Phone: 478-272-7858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number017020
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: