Provider Demographics
NPI:1881078590
Name:MCDOWELL, CHARLIE LEWIS
Entity type:Individual
Prefix:
First Name:CHARLIE
Middle Name:LEWIS
Last Name:MCDOWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 NEW HOPE DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-7122
Mailing Address - Country:US
Mailing Address - Phone:678-814-4827
Mailing Address - Fax:678-814-4245
Practice Address - Street 1:66 NEW HOPE DR
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30252-7122
Practice Address - Country:US
Practice Address - Phone:678-814-4827
Practice Address - Fax:678-814-4245
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)