Provider Demographics
NPI:1346261195
Name:FILLINGANE, CHARLES SAMUEL (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:SAMUEL
Last Name:FILLINGANE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 N FLOWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9533
Mailing Address - Country:US
Mailing Address - Phone:601-664-2424
Mailing Address - Fax:601-664-6675
Practice Address - Street 1:27 LAKE FORGETFUL APT 528
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-8275
Practice Address - Country:US
Practice Address - Phone:601-906-9389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11114207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D73508Medicare UPIN