Provider Demographics
NPI:1558367193
Name:BEDINGFIELD, CARL O (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:O
Last Name:BEDINGFIELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 ROBERSON ST
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-2938
Mailing Address - Country:US
Mailing Address - Phone:478-272-7858
Mailing Address - Fax:
Practice Address - Street 1:2406 BELLEVUE RD
Practice Address - Street 2:BLDG. 10
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2842
Practice Address - Country:US
Practice Address - Phone:478-272-2623
Practice Address - Fax:478-272-9984
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA017020208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics