Provider Demographics
NPI:1578802286
Name:CHARLOT, MARY J (FNP-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:CHARLOT
Suffix:
Gender:F
Credentials:FNP-C
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:618 THORNTON RD STE 3-440
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-1518
Mailing Address - Country:US
Mailing Address - Phone:770-927-7341
Mailing Address - Fax:888-700-9062
Practice Address - Street 1:870 CRESTMARK DR STE 200
Practice Address - Street 2:
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-2665
Practice Address - Country:US
Practice Address - Phone:770-927-7341
Practice Address - Fax:888-700-9062
Is Sole Proprietor?:No
Enumeration Date:2013-02-01
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA187056363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily