Provider Demographics
NPI:1962484915
Name:GERY, CHARLES S JR (PA-C)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:S
Last Name:GERY
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 277730
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-7730
Mailing Address - Country:US
Mailing Address - Phone:615-373-7600
Mailing Address - Fax:
Practice Address - Street 1:1802 BRAEBURN DR
Practice Address - Street 2:SUITE 1310
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7357
Practice Address - Country:US
Practice Address - Phone:540-776-2020
Practice Address - Fax:540-776-2017
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110840469363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00413631OtherMEDICARE RR
VA1962484915Medicaid
VAP00453914OtherRAILROAD MEDICARE
R36236Medicare UPIN
VA1962484915Medicaid
013960C65Medicare PIN
C10065Medicare PIN