Provider Demographics
NPI:1639133838
Name:MACNEILL, CHARLES A (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:A
Last Name:MACNEILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:790 CHURCH ST NE
Mailing Address - Street 2:SUITE 550
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7282
Mailing Address - Country:US
Mailing Address - Phone:770-419-9902
Mailing Address - Fax:770-419-7457
Practice Address - Street 1:5730 GLENRIDGE DR NE
Practice Address - Street 2:SUITE 100
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-6141
Practice Address - Country:US
Practice Address - Phone:404-816-3000
Practice Address - Fax:678-904-5797
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2011-01-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA021543207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1710946322OtherGROUP NPI NUMBER
GA1647492OtherCIGNA
GA050044294Medicare PIN
GA05BDFBBMedicare PIN
GA1710946322OtherGROUP NPI NUMBER