Provider Demographics
NPI:1396789897
Name:MCCORD, CHARLES (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:MCCORD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 71879
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30271-1879
Mailing Address - Country:US
Mailing Address - Phone:770-252-5290
Mailing Address - Fax:770-252-5295
Practice Address - Street 1:3345 HIGHWAY 34 E
Practice Address - Street 2:SUITE 102
Practice Address - City:SHARPSBURG
Practice Address - State:GA
Practice Address - Zip Code:30277-3563
Practice Address - Country:US
Practice Address - Phone:770-252-5290
Practice Address - Fax:770-252-5295
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA039406207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAA47718Medicare UPIN