Provider Demographics
NPI:1891873840
Name:SNOW, CHARLES C (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:C
Last Name:SNOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6501 PEAKE RD
Mailing Address - Street 2:#700
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-8042
Mailing Address - Country:US
Mailing Address - Phone:478-476-9285
Mailing Address - Fax:478-474-9034
Practice Address - Street 1:6501 PEAKE RD
Practice Address - Street 2:#700
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-8042
Practice Address - Country:US
Practice Address - Phone:478-476-9285
Practice Address - Fax:478-474-9034
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041367207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00864311AMedicaid
GA110205944OtherRAILROAD MEDICARE
GA357430OtherWELLCARE
GA110205944OtherRAILROAD MEDICARE
GA00864311AMedicaid