Healthcare Provider Details

I. General information

NPI: 1851356463
Provider Name (Legal Business Name): HEARNS CHARLES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1439 CLIFTON RD NE STE AG05
ATLANTA GA
30322-4395
US

IV. Provider business mailing address

5300 W HILLSBORO BLVD STE 107
COCONUT CREEK FL
33073-4395
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-4747
  • Fax: 404-686-2226
Mailing address:
  • Phone: 954-725-4141
  • Fax: 954-725-4141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME125571
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number90085
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: