Provider Demographics
NPI:1346396405
Name:STEPHENS, CHARLES NOLAN (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:NOLAN
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:C. NOLAN
Other - Middle Name:
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:961 N. COLUMBIA ST.
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061
Mailing Address - Country:US
Mailing Address - Phone:478-452-6162
Mailing Address - Fax:478-452-9678
Practice Address - Street 1:961 N. COLUMBIA ST.
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061
Practice Address - Country:US
Practice Address - Phone:478-452-6162
Practice Address - Fax:478-452-9678
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4889111NR0400X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
352CCJXMedicare PIN
GA35ZCCJXMedicare UPIN
U41924Medicare UPIN