Provider Demographics
NPI:1407027782
Name:DUKE, CHARLES WESSINGER (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WESSINGER
Last Name:DUKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:101 RIVERSTONE VISTA
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30153-6631
Mailing Address - Country:US
Mailing Address - Phone:706-258-4400
Mailing Address - Fax:706-258-4404
Practice Address - Street 1:101 RIVERSTONE VISTA
Practice Address - Street 2:SUITE 106
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30153-6631
Practice Address - Country:US
Practice Address - Phone:706-258-4400
Practice Address - Fax:706-258-4404
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA054779207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA149961Medicare UPIN