MEDICARE: DR. CHARLES C SNOW M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	041367	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	110205944	OTHER	GA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	357430	OTHER	GA	WELLCARE

General Provider Information

NPI Number	:	1891873840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES C SNOW M.D.

Provider Business Mailing Address
First Line	:	6501 PEAKE RD
Second Line	:	#700
City	:	MACON
State	:	GA
Zip	:	31210-8042
Country	:	US
Telephone Number	:	478-476-9285
Fax Number	:	478-474-9034

Provider Business Practice Location Address
First Line	:	6501 PEAKE RD
Second Line	:	#700
City	:	MACON
State	:	GA
Zip	:	31210-8042
Country	:	US
Telephone Number	:	478-476-9285
Fax Number	:	478-474-9034

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	08/18/2010

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