Provider Demographics
NPI:1881675700
Name:BEDGOOD, RAYMOND BRADLEY (DO)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:BRADLEY
Last Name:BEDGOOD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 3RD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-3293
Mailing Address - Country:US
Mailing Address - Phone:478-464-2600
Mailing Address - Fax:478-742-0090
Practice Address - Street 1:610 3RD ST STE 202
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-3262
Practice Address - Country:US
Practice Address - Phone:478-464-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052054207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11SCDPHMedicare PIN
GAI23636Medicare UPIN