Provider Demographics
NPI:1437173556
Name:BETZ, CHARLES JOSEPH (MD PC)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:JOSEPH
Last Name:BETZ
Suffix:
Gender:M
Credentials:MD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 JOHN MADDOX DR
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165
Mailing Address - Country:US
Mailing Address - Phone:706-235-3033
Mailing Address - Fax:706-295-7993
Practice Address - Street 1:100 JOHN MADDOX DR NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1431
Practice Address - Country:US
Practice Address - Phone:706-235-3033
Practice Address - Fax:706-295-7993
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA17130207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000132613AMedicaid
GA000132613AMedicaid
GA$$$$$$$$$AMedicare PIN