Provider Demographics
NPI:1225477300
Name:CHARLES, MANDI (RN)
Entity Type:Individual
Prefix:
First Name:MANDI
Middle Name:
Last Name:CHARLES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
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Mailing Address - Street 1:975 JOHNSON FY RD NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1619
Mailing Address - Country:US
Mailing Address - Phone:404-256-1311
Mailing Address - Fax:404-705-2774
Practice Address - Street 1:1400 NORTHSIDE FORSYTH DR
Practice Address - Street 2:SUITE 390
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7668
Practice Address - Country:US
Practice Address - Phone:404-256-1311
Practice Address - Fax:404-705-2774
Is Sole Proprietor?:No
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN165071163WS0121X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery