Healthcare Provider Details

I. General information

NPI: 1861028466
Provider Name (Legal Business Name): CHARLES FRANKLIN HORTENSTINE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2020
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 OLD JEFFERSON RD BLDG 800
ATHENS GA
30607-1476
US

IV. Provider business mailing address

3320 OLD JEFFERSON RD BLDG 800
ATHENS GA
30607-1476
US

V. Phone/Fax

Practice location:
  • Phone: 706-353-2990
  • Fax: 706-353-2992
Mailing address:
  • Phone: 706-353-2990
  • Fax: 706-353-2992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number9680
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: