Provider Demographics
NPI:1356312979
Name:OGBURN, CHARLES L JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:L
Last Name:OGBURN
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:330 HOSPITAL DR
Mailing Address - Street 2:BLDG C, STE 200
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-3899
Mailing Address - Country:US
Mailing Address - Phone:478-745-1191
Mailing Address - Fax:478-752-3869
Practice Address - Street 1:330 HOSPITAL DR
Practice Address - Street 2:BLDG C, STE 200
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-3899
Practice Address - Country:US
Practice Address - Phone:478-745-1191
Practice Address - Fax:478-752-3869
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2009-12-15
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Provider Licenses
StateLicense IDTaxonomies
GA019576207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00163622AMedicaid
GAD30378Medicare UPIN