Provider Demographics
NPI:1861028466
Name:HORTENSTINE, CHARLES FRANKLIN (PA-C)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:FRANKLIN
Last Name:HORTENSTINE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1800 HOWELL MILL RD NW STE 575
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-2538
Mailing Address - Country:US
Mailing Address - Phone:678-949-2830
Mailing Address - Fax:404-477-1162
Practice Address - Street 1:1267 HIGHWAY 54 W STE 4200
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-2112
Practice Address - Country:US
Practice Address - Phone:678-829-1060
Practice Address - Fax:678-829-1099
Is Sole Proprietor?:No
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA9680363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical