Provider Demographics
NPI:1639110687
Name:SEMONES, CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:SEMONES
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 1:380 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:HOMERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31634-2452
Mailing Address - Country:US
Mailing Address - Phone:912-487-1737
Mailing Address - Fax:912-487-1739
Practice Address - Street 1:380 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:HOMERVILLE
Practice Address - State:GA
Practice Address - Zip Code:31634-2452
Practice Address - Country:US
Practice Address - Phone:912-487-1737
Practice Address - Fax:912-487-1739
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-064564207PE0004X
GA051737207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036064564-1Medicaid
IL05721369OtherBC/BS
ILK19627Medicare ID - Type Unspecified
IL036064564-1Medicaid