Provider Demographics
NPI:1275579112
Name:TEESLINK, CHARLES REX (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:REX
Last Name:TEESLINK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2634 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-4656
Mailing Address - Country:US
Mailing Address - Phone:706-373-5771
Mailing Address - Fax:706-733-4836
Practice Address - Street 1:2634 HENRY ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-4656
Practice Address - Country:US
Practice Address - Phone:706-373-5771
Practice Address - Fax:706-733-4836
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0133102085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA684977604AMedicaid
GA30BDMHQMedicare ID - Type Unspecified
GAD30986Medicare UPIN