MICHAEL THOMAS BERGQUIST (NPI# 1396263588) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396263588 |
| Entity Type | Individual |
| Full Name | MICHAEL THOMAS BERGQUIST |
| Credential | LPC |
| Practice Address |
1637 Athens Hwy Grayson GA 30017-1768 |
| Practice Telephone | 6783448268 |
| Practice Fax Number | 8886276444 |
| Mailing Telephone | 6783448268 |
| Mailing Fax Number | 8886276444 |
| Enumeration Date | 2017-09-07 |
| Last Update Date | 2017-09-07 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YP2500X |
Counselor Specialization: Professional |
LPC008976 | GA | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104040658 | Michael Bergquist | Pharmacist | 1321 E 4000 S, Salt Lake City, UT 84124-1446 | 2007-04-13 |
| 1033644927 | Michael Bergquist | Radiology | Uw Hospitals and Clinics 600 Highland Ave, Madison, WI 53792-0001 | 2017-04-27 |
| 1447488911 | Michael Robert Bergquist | Dentist | 12002 Sw 128th Ct, Suite #108, Miami, FL 33186-4639 | 2009-06-23 |
| 1174570303 | Michael Bergquist | Internal Medicine | 100 Michigan St Ne, Suite A721, Grand Rapids, MI 49503-2560 | 2006-05-31 |
| Street Address |
1637 ATHENS HWY |
| City | GRAYSON |
| State | GA |
| Zip Code | 30017-1768 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588841977 | Kelli Nicole Bridgman | Nurse Practitioner | 1637 Athens Hwy, Grayson, GA 30017-1768 | 2008-01-28 |
| 1457802373 | Delia Harriet Williams | Counselor | 1637 Athens Hwy, Grayson, GA 30017-1768 | 2016-10-14 |
| 1023483070 | Courtney Dombrowski | Counselor | 1637 Athens Hwy, Grayson, GA 30017-1768 | 2015-12-02 |
| 1538461652 | Donna L. Cochran-harrow | Social Worker | 1637 Athens Hwy, Grayson, GA 30017-1768 | 2010-11-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588140859 | Butterfly Development, LLC | Community Based Residential Treatment Facility, Mental Illness | 1911 Grayson Highway, Suite 8-242, Grayson, GA 30017 | 2018-07-19 |
| 1811417132 | Yva Gauthier | Nurse Practitioner | 1620 Terry Mill Lane, Grayson, GA 30017 | 2017-06-27 |
| 1023341518 | Christine R Petro, Psy.d., LLC | Psychologist | 69 Grayson New Hope Rd, Grayson, GA 30017 | 2009-09-15 |
| 1902097579 | Zain Odeh Dabbas | Dentist | 2594 Loganviile Hwy, # 102, Grayson, GA 30017 | 2007-08-07 |
| 1619078276 | Primary Foot & Ankle Care | Podiatrist | 862 Amber Hill Ct, Grayson, GA 30017 | 2006-09-26 |
| 1700878170 | James Michael Long | Dentist | 2518 Loganville Hwy, Grayson, GA 30017 | 2005-08-22 |
| 1629556717 | Mason Moriah Earp | Physical Therapist | 2065 Grayson Hwy Ste B, Grayson, GA 30017 | 2018-08-01 |
| 1811482201 | Matthew Ntomoo Lo | Physical Therapy Assistant | 2065 Grayson Hwy Ste B, Grayson, GA 30017 | 2018-06-27 |
| 1144460668 | Alisa M Nelson-wade | Dentist | 2219 Loganville Hwy, Hwy 20, Grayson, GA 30017 | 2009-02-24 |
| 1003321662 | Grace Care Ambulance Transport, LLC | Ambulance | 516 Sosebee Farm Rd Unit 531, Grayson, GA 30017-0118 | 2017-12-05 |
| Find all providers in zip 30017 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801212337 | Laura 'kay' Watson | Counselor | 2047 Grayson Hwy # 20, Grayson, GA 30017-1242 | 2014-03-07 |
| 1609061373 | A Life's Journey, Inc. | Counselor | 512 Grayson Pkwy, Grayson, GA 30017-1216 | 2007-09-06 |
| 1194331157 | Richard J Lee II | Counselor | 840 Interstate Dr, Grayson, KY 41143-1768 | 2020-09-16 |
| 1457802373 | Delia Harriet Williams | Counselor | 1637 Athens Hwy, Grayson, GA 30017-1768 | 2016-10-14 |
| 1194121137 | Gara Wilson-casteel | Counselor | 59 Fivco Ct, Grayson, KY 41143-6107 | 2014-11-18 |
| 1013312164 | Kelly J Conley | Counselor | 59 Fivco Ct, Grayson, KY 41143-6107 | 2014-10-31 |
| 1780943290 | Melissa Brown | Counselor | 59 Fivco Ct, Grayson, KY 41143-6107 | 2012-05-04 |
| 1366721615 | Jennifer Ann Nichols | Counselor | 840 Interstate Dr, Grayson, KY 41143-1768 | 2011-08-04 |
| 1356591325 | Nathan Parrish | Counselor | 840 Interstate Dr, Grayson, KY 41143-1768 | 2008-09-25 |
| 1740476589 | A Life's Journey, Inc. | Counselor | 512 Grayson Pkwy, Grayson, GA 30017-1216 | 2007-09-14 |
| Find all providers in GRAYSON | ||||
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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.