Provider Demographics
NPI:1114140704
Name:HARE, CHARMILLE AIMESA GARNETT (DO)
Entity Type:Individual
Prefix:
First Name:CHARMILLE
Middle Name:AIMESA GARNETT
Last Name:HARE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5040 BILL GARDNER PKWY
Mailing Address - Street 2:SUITE 310
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-3757
Mailing Address - Country:US
Mailing Address - Phone:770-898-4339
Mailing Address - Fax:770-898-4134
Practice Address - Street 1:5040 BILL GARDNER PKWY
Practice Address - Street 2:SUITE 310
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248-3757
Practice Address - Country:US
Practice Address - Phone:770-898-4339
Practice Address - Fax:770-898-4134
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2016-01-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA063069207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I084381Medicare PIN