Provider Demographics
NPI:1821044868
Name:CORLEY, CHARLES A (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:A
Last Name:CORLEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1121 JOHNSON FERRY RD
Mailing Address - Street 2:STE 220
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068
Mailing Address - Country:US
Mailing Address - Phone:770-977-0094
Mailing Address - Fax:770-509-5177
Practice Address - Street 1:1121 JOHNSON FERRY RD
Practice Address - Street 2:STE 220
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068
Practice Address - Country:US
Practice Address - Phone:770-977-0094
Practice Address - Fax:770-509-5177
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
GAO55667208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics