Charles E Bagley MDPC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

010858 Issued in GA

Legal business name

CHARLES E BAGLEY MDPC

Practice address

210 E 16TH Street
Alma, GA 31510

Phone

(912) 632-7203

Fax

(912) 632-6491

NPI assigned

Aug 17, 2006

Last updated

Mar 5, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Charles E Bagley

Title

Owner

Phone

(912) 632-7203

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1267747200000",
    "number": "1093829343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 220",
            "city": "ALMA",
            "state": "GA",
            "postal_code": "31510",
            "telephone_number": "912-632-7203",
            "fax_number": "912-632-6491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 E 16TH STREET",
            "city": "ALMA",
            "state": "GA",
            "postal_code": "31510",
            "telephone_number": "912-632-7203",
            "fax_number": "912-632-6491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES E BAGLEY MDPC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-17",
        "last_updated": "2010-03-05",
        "status": "A",
        "authorized_official_last_name": "BAGLEY",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "912-632-7203"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "010858",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000098733A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.