Provider Demographics
NPI:1336357060
Name:BAGGETT, CHARLES BRANDON (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:BRANDON
Last Name:BAGGETT
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 1:221 TECHNOLOGY PKWY NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1369
Mailing Address - Country:US
Mailing Address - Phone:762-235-1000
Mailing Address - Fax:
Practice Address - Street 1:504 REDMOND RD NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1416
Practice Address - Country:US
Practice Address - Phone:706-235-3855
Practice Address - Fax:706-290-2382
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA063395207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA347408410CMedicaid
GA347408410EMedicaid
GA347408410GMedicaid
GA347408410AMedicaid
GA347408410BMedicaid
GA347408410HMedicaid
GA347408410DMedicaid
GA347408410FMedicaid
GA347408410BMedicaid