Provider Demographics
NPI:1407842859
Name:GEBHARDT, CHARLES F (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:F
Last Name:GEBHARDT
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 1:2601 STUART AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-1664
Mailing Address - Country:US
Mailing Address - Phone:229-405-8900
Mailing Address - Fax:229-405-8901
Practice Address - Street 1:2002 PALMYRA RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701
Practice Address - Country:US
Practice Address - Phone:229-889-9367
Practice Address - Fax:229-317-0678
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA028778207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000328732CMedicaid
GAAG2859897OtherRR MEDICARE
GA11BDPZFMedicare PIN
GA000328732CMedicaid