Provider Demographics
NPI:1063476729
Name:PATORGIS, CHARLES J (OD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:J
Last Name:PATORGIS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 CUMBERLAND BLVD SE
Mailing Address - Street 2:SUITE 900
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-6407
Mailing Address - Country:US
Mailing Address - Phone:404-351-2220
Mailing Address - Fax:404-355-5624
Practice Address - Street 1:3225 CUMBERLAND BLVD SE
Practice Address - Street 2:SUITE 900
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-6407
Practice Address - Country:US
Practice Address - Phone:404-351-2220
Practice Address - Fax:404-355-5624
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000961152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000521111AMedicaid
GAC30849Medicare PIN
GA00965Medicare PIN
GAU37693Medicare UPIN
GA441ZCCDSMedicare ID - Type Unspecified