Provider Demographics
NPI:1134157571
Name:SPURR, CHARLES LEWIS JR (M D)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:LEWIS
Last Name:SPURR
Suffix:JR
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:820 SAINT SEBASTIAN WAY
Mailing Address - Street 2:SUITE 5B
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2643
Mailing Address - Country:US
Mailing Address - Phone:706-722-2400
Mailing Address - Fax:706-724-9211
Practice Address - Street 1:820 SAINT SEBASTIAN WAY
Practice Address - Street 2:SUITE 5B
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2643
Practice Address - Country:US
Practice Address - Phone:706-722-2400
Practice Address - Fax:706-724-9211
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA24728207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00268364BMedicaid
GAD42035Medicare UPIN