Active NPI
Grace Bogert, PA-C
- Physician Assistant
- Stockbridge, GA
National Provider Identifier
1831195262
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 003631
- Practice address
- 210 Village Center Pkwy
Stockbridge, GA 30281-9044 - Phone
- (770) 474-5952
- Fax
- (770) 474-1300
- NPI assigned
- Jun 21, 2005
- Last updated
- Apr 17, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 003631 | GA | Primary |
Addresses
Primary practice location
210 Village Center Pkwy
Stockbridge, GA 30281-9044
Mailing address
210 Village Center Pkwy
Stockbridge, GA 30281-9044
Phone (770) 474-5952
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6537 | Other | GA | KAISER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 003631 | GA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1119312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1208390400000",
"number": "1831195262",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "210 VILLAGE CENTER PKWY",
"city": "STOCKBRIDGE",
"state": "GA",
"postal_code": "302819044",
"telephone_number": "770-474-5952",
"fax_number": "770-474-1300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 VILLAGE CENTER PKWY",
"city": "STOCKBRIDGE",
"state": "GA",
"postal_code": "302819044",
"telephone_number": "770-474-5952",
"fax_number": "770-474-1300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOGERT",
"first_name": "GRACE",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-06-21",
"last_updated": "2008-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "GA",
"license": "003631",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KAISER",
"identifier": "6537",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Stockbridge, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.