Provider Demographics
NPI:1891735577
Name:YOUMANS, CHARLES-ALBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES-ALBERT
Middle Name:
Last Name:YOUMANS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5153 BLUEGRASS TRL
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-4213
Mailing Address - Country:US
Mailing Address - Phone:706-787-3164
Mailing Address - Fax:706-787-0271
Practice Address - Street 1:300 EAST HOSPITAL ROAD
Practice Address - Street 2:EISENHOWER ARMY MEDICAL CENTER
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905
Practice Address - Country:US
Practice Address - Phone:706-787-3164
Practice Address - Fax:706-787-0271
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018091207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE60723Medicare UPIN