Provider Demographics
NPI:1124002050
Name:HAENDEL, CHARLES R (DPM)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:R
Last Name:HAENDEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:55 WHITCHER ST NE
Mailing Address - Street 2:STE 450
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1155
Mailing Address - Country:US
Mailing Address - Phone:770-590-4188
Mailing Address - Fax:770-590-4189
Practice Address - Street 1:55 WHITCHER ST NE
Practice Address - Street 2:STE 450
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1155
Practice Address - Country:US
Practice Address - Phone:770-590-4188
Practice Address - Fax:770-590-4189
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000583213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000377869GMedicaid
GA024633OtherBC
GA0575829OtherAETNA
GA024633OtherBC
T62093Medicare UPIN