Provider Demographics
NPI:1467492785
Name:EDENFIELD, CHARLES S (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:S
Last Name:EDENFIELD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:623 S HOUSTON LAKE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-9093
Mailing Address - Country:US
Mailing Address - Phone:478-922-9842
Mailing Address - Fax:478-923-8444
Practice Address - Street 1:623 S HOUSTON LAKE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-9093
Practice Address - Country:US
Practice Address - Phone:478-922-9842
Practice Address - Fax:478-923-8444
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA030052207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00354362DMedicaid
GA00354362DMedicaid
GAD29376Medicare UPIN