Provider Demographics
NPI:1538131412
Name:HANCOCK, CHARLES E (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:HANCOCK
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:PO BOX 2968
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31799-2968
Mailing Address - Country:US
Mailing Address - Phone:229-226-9141
Mailing Address - Fax:229-228-0637
Practice Address - Street 1:100 MIMOSA DR
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-6676
Practice Address - Country:US
Practice Address - Phone:229-226-9141
Practice Address - Fax:229-228-0637
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA033979207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000459335AOtherPEACH STATE
GA000459335AMedicaid
GA344327OtherWELLCARE
GA200009783OtherRAIL ROAD MEDICARE
E81467Medicare UPIN
GA0832790001Medicare NSC
GA20BDBMGMedicare PIN