Provider Demographics
NPI:1174503585
Name:NASH, CHARLES HENRY III (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:HENRY
Last Name:NASH
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-0658
Mailing Address - Country:US
Mailing Address - Phone:770-718-1122
Mailing Address - Fax:770-535-7445
Practice Address - Street 1:725 JESSE JEWELL PKWY SE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3834
Practice Address - Country:US
Practice Address - Phone:770-297-5700
Practice Address - Fax:770-718-1877
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048068207RH0000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA329963OtherWELLCARE
GA3600016OtherUNITED HEALTHCARE
GA10044870OtherAMERIGROUP
GA110231727OtherRR MEDICARE-GRP # CC4177
GA52668899OtherBCBS
GA000847547BMedicaid
GA3780410OtherCIGNA
GA000847547AMedicaid
GAD42693Medicare UPIN
GA000847547BMedicaid