Healthcare Provider Details

I. General information

NPI: 1942234281
Provider Name (Legal Business Name): CHARLES EDWARD GARTEN II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 DOWNWOOD CIR NW STE 340
ATLANTA GA
30327-1605
US

IV. Provider business mailing address

3280 HOWELL MILL RD NW STE 250
ATLANTA GA
30327-4116
US

V. Phone/Fax

Practice location:
  • Phone: 404-352-8156
  • Fax: 404-350-9405
Mailing address:
  • Phone: 404-352-8156
  • Fax: 404-350-9405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number056449
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: