Provider Demographics
NPI:1730284480
Name:CHARRT,INC.
Entity Type:Organization
Organization Name:CHARRT,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:WOOLLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-724-4045
Mailing Address - Street 1:820 SAINT SEBASTIAN WAY
Mailing Address - Street 2:SUITE 5A
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2643
Mailing Address - Country:US
Mailing Address - Phone:706-724-4045
Mailing Address - Fax:706-724-4041
Practice Address - Street 1:191 CENTRE SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-6313
Practice Address - Country:US
Practice Address - Phone:803-642-4045
Practice Address - Fax:803-642-4041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042002207RN0300X
SC15566207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN06701Medicaid
GA39BDCKHMedicare ID - Type Unspecified
GAE39234Medicare UPIN
SC8143Medicare PIN