Provider Demographics
NPI:1659379642
Name:HARTLEY, CHARLES BRYCE II (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:BRYCE
Last Name:HARTLEY
Suffix:II
Gender:M
Credentials:MD
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Mailing Address - Street 1:3820 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1110
Mailing Address - Country:US
Mailing Address - Phone:770-948-5409
Mailing Address - Fax:770-948-7994
Practice Address - Street 1:2045 PEACHTREE RD NE
Practice Address - Street 2:SUITE T1
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1414
Practice Address - Country:US
Practice Address - Phone:770-948-6041
Practice Address - Fax:770-739-5411
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2018-03-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA028994207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00358916AMedicaid
GA00358916AMedicaid