Provider Demographics
NPI:1598066037
Name:BARTHOLOMEW, CHARLES (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:BARTHOLOMEW
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2612 COUNTRY CLUB DR SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-4913
Mailing Address - Country:US
Mailing Address - Phone:770-820-3181
Mailing Address - Fax:
Practice Address - Street 1:2385 WALL STREET
Practice Address - Street 2:WALL STREET EXECUTIVE SUITES
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013
Practice Address - Country:US
Practice Address - Phone:770-820-3181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1422103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist