Provider Demographics
NPI:1720054349
Name:NECKMAN, CHARLES B (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:B
Last Name:NECKMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 48089
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30604-8089
Mailing Address - Country:US
Mailing Address - Phone:706-389-3740
Mailing Address - Fax:706-389-3951
Practice Address - Street 1:2470 DANIELS BRIDGE RD STE 251
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6192
Practice Address - Country:US
Practice Address - Phone:706-389-3440
Practice Address - Fax:706-353-2205
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA24471207RI0011X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD30330Medicare UPIN
GAD30330Medicare UPIN
GA006592OtherBLUE CROSS & BLUE SHIELD
GA06BDHDZMedicare ID - Type Unspecified