DR. CHARLES A BAGWELL (NPI# 1366417479) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366417479 |
| Entity Type | Individual |
| Full Name | DR. CHARLES A BAGWELL |
| Credential | MD |
| Practice Address |
100 Doctors Dr Ste C Douglas GA 31533-2211 |
| Mailing Address |
1100 Ward Street Ext W Douglas GA 31533-1902 |
| Practice Telephone | 9123845832 |
| Practice Fax Number | 9123838279 |
| Mailing Telephone | (912) 384-1477 |
| Mailing Fax Number | 9123841470 |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2018-03-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208600000X | Surgery | 050494 | GA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 000919729B | 05 | |
| GA | MEDICAL LICENSE | 050494 | 01 |
| GA | RAILROAD MEDICARE - PALMETTO GBA | GROUP #DH1281 | 01 |
| GA | RAILROAD MEDICARE - PALMETTO GBA | PTAN P00473716 | 01 |
| GA | CLIA ID - 1309 OCILLA RD STE A | 11D0265294 | 01 |
| GA | DEA | BB7452117 | 01 |
| GA | PEACHSTATE | 129049 | 01 |
| GA | 000919729C | 05 | |
| GA | CLIA ID - 17 JOHNSON ST | 11D1105865 | 01 |
| GA | GA LICENSE | 050494 | 01 |
| GA | WELLCARE OF GEORGIA | 341153 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 204 E 15th St, Alma, GA 315102908 | 9123845832 | 9123838279 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710903893 | Charles Bagwell | Physical Therapist | 19768 Yorba Linda Blvd, Yorba Linda, CA 92886-2801 | 2006-07-14 |
| 1265423735 | Charles E Bagwell | Surgery | 7101 Jahnke Rd, Richmond, VA 23225-4017 | 2005-11-02 |
| Street Address |
100 DOCTORS DR STE C |
| City | DOUGLAS |
| State | GA |
| Zip Code | 31533-2211 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336132646 | Romulo P Navarro | Surgery | 100 Doctors Dr Ste C, Douglas, GA 31533-2211 | 2005-08-23 |
| 1194974816 | Chester Theo Royals Jr. | Surgery | 100 Doctors Dr Ste C, Douglas, GA 31533-2211 | 2008-09-18 |
| 1932280682 | Thomas W Wehmann | Surgery | 100 Doctors Dr Ste C, Douglas, GA 31533-2211 | 2006-10-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508470964 | Swain Drug Company LLC | Pharmacy | 855 Bowens Mill Rd Sw Suite E, Douglas, GA 31533 | 2020-09-03 |
| 1811528649 | Unison Behavioral Health | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 211 North Street, Douglas, GA 31533 | 2020-01-30 |
| 1952940793 | Teresa Smith | Pharmacist | 901 W Ward St, Douglas, GA 31533 | 2019-12-26 |
| 1447641048 | Jennifer Spivey | Nurse Practitioner | 326 Shirley Avenue, Douglas, GA 31533 | 2015-02-18 |
| 1972914497 | Jessica Lynne Courson | Nurse Practitioner | 903 West Ward Street, Suite B, Douglas, GA 31533 | 2014-05-19 |
| 1063840296 | South Central Primary Care Center | Clinic/Center | 303 Shirley Ave, Ste B, Douglas, GA 31533 | 2013-10-25 |
| 1336411008 | Unison Behavioral Health | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 118 Coweta Avenue South, Douglas, GA 31533 | 2012-01-27 |
| 1346482700 | V and V Clinic | Pediatrics | 1020 West Bryan Street, Douglas, GA 31533 | 2009-04-01 |
| 1063650406 | Jayla Snipes Bullock | Speech-Language Pathologist | 618 Bowens Mill Road Sw, Douglas, GA 31533 | 2009-01-22 |
| 1417112707 | Southern Community Services Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 315 S. Gaskin Ave, Douglas, GA 31533 | 2008-07-25 |
| Find all providers in zip 31533 | ||||
| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013277904 | Otis Rodney Vickers | Surgery | 917 Karen Ln, Douglas, GA 31533-3401 | 2012-05-24 |
| 1730126194 | Concordio F Ursal | Surgery | 2106 Ocilla Rd, Douglas, GA 31533 | 2006-06-02 |
| 1205829207 | William Charles Miller Jr. | Surgery | 203 Shirley Ave, Douglas, GA 31533-2327 | 2005-08-24 |
| 1336132646 | Romulo P Navarro | Surgery | 100 Doctors Dr Ste C, Douglas, GA 31533-2211 | 2005-08-23 |
| 1023418928 | Irwin County Hospital | Surgery | 2016 Ocilla Rd, Douglas, GA 31533-2230 | 2014-08-27 |
| 1710205927 | Douglas Medical & Surgical Group, PC | Surgery | 203 Shirley Ave, Douglas, GA 31533-2327 | 2010-05-12 |
| 1194974816 | Chester Theo Royals Jr. | Surgery | 100 Doctors Dr Ste C, Douglas, GA 31533-2211 | 2008-09-18 |
| 1598827974 | Medical South PC | Surgery | 1309 Ocilla Rd, Suite A, Douglas, GA 31533-2209 | 2006-12-14 |
| 1932280682 | Thomas W Wehmann | Surgery | 100 Doctors Dr Ste C, Douglas, GA 31533-2211 | 2006-10-18 |
| 1992808398 | Jonathan L Grosdidier | Surgery | 111 S 5th St, Douglas, WY 82633-2434 | 2006-09-07 |
| Find all providers in DOUGLAS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.