Provider Demographics
NPI:1841472180
Name:CHARLES G.MCCLURE,M.D.,PC
Entity type:Organization
Organization Name:CHARLES G.MCCLURE,M.D.,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:WHITMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-722-8817
Mailing Address - Street 1:1303 DANTIGNAC ST
Mailing Address - Street 2:SUITE 2800
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2775
Mailing Address - Country:US
Mailing Address - Phone:706-722-8817
Mailing Address - Fax:706-722-3315
Practice Address - Street 1:1303 DANTIGNAC ST
Practice Address - Street 2:SUITE 2800
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2775
Practice Address - Country:US
Practice Address - Phone:706-722-8817
Practice Address - Fax:706-722-3315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0176302084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC906737Medicaid
SC906737Medicaid