Provider Demographics
NPI:1952565947
Name:BECHERT, CHARLES J (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:J
Last Name:BECHERT
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 1:180 N PARK TRAIL
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7372
Mailing Address - Country:US
Mailing Address - Phone:678-902-9412
Mailing Address - Fax:
Practice Address - Street 1:180 N PARK TRAIL
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7372
Practice Address - Country:US
Practice Address - Phone:678-902-9412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-18
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA80332207ZC0500X, 207ZP0101X
MDD0064987208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice