Provider Demographics
NPI:1124224753
Name:EMERSON, CHARLES WHITLEY III (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WHITLEY
Last Name:EMERSON
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:4300 N POINT PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-4102
Mailing Address - Country:US
Mailing Address - Phone:770-442-1911
Mailing Address - Fax:770-442-0306
Practice Address - Street 1:1612 HIGHWAY 78 EAST
Practice Address - Street 2:SUITE 100
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203-5862
Practice Address - Country:US
Practice Address - Phone:256-835-4756
Practice Address - Fax:256-831-5736
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2023-08-31
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Provider Licenses
StateLicense IDTaxonomies
AL22535207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H10403Medicare UPIN