Provider Demographics
NPI:1962463943
Name:GEORGE, CHARMAINE M (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARMAINE
Middle Name:M
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9019 GARNERS FERRY RD
Mailing Address - Street 2:STE B
Mailing Address - City:HOPKINS
Mailing Address - State:SC
Mailing Address - Zip Code:29061-9687
Mailing Address - Country:US
Mailing Address - Phone:803-699-8444
Mailing Address - Fax:803-699-8440
Practice Address - Street 1:9019 GARNERS FERRY RD STE B
Practice Address - Street 2:STE B
Practice Address - City:HOPKINS
Practice Address - State:SC
Practice Address - Zip Code:29061-9687
Practice Address - Country:US
Practice Address - Phone:803-699-8444
Practice Address - Fax:803-699-8440
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15964207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCFQC030Medicaid
SCFQC043Medicaid
WI421841Medicare Oscar/Certification
SCF22507Medicare UPIN
WI421892Medicare Oscar/Certification
SC7131Medicare PIN
SCFQC030Medicaid