Provider Demographics
NPI:1881621886
Name:CATRON, CHARLES PAUL (MD,)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:PAUL
Last Name:CATRON
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:2660 REIDVILLE RD UNIT 1
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-3512
Practice Address - Country:US
Practice Address - Phone:864-560-9696
Practice Address - Fax:864-560-9636
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA066362207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC175054Medicaid
GA003109893AMedicaid
TNSC89216067OtherMEDICARE PIN
GA202I204909Medicare PIN
KY64339385Medicaid