Provider Demographics
NPI:1699020057
Name:ROWE, CHEREESE BEDINGFIELD (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CHEREESE
Middle Name:BEDINGFIELD
Last Name:ROWE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-2548
Mailing Address - Country:US
Mailing Address - Phone:478-275-3782
Mailing Address - Fax:478-275-8937
Practice Address - Street 1:101 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2548
Practice Address - Country:US
Practice Address - Phone:478-275-3782
Practice Address - Fax:478-275-8937
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006496363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003128037FMedicaid
GA003141398AMedicaid