Healthcare Provider Details

I. General information

NPI: 1245334705
Provider Name (Legal Business Name): CHARLOTTE ANNE MASSAD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 03/07/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5445 MERIDIAN MARKS RD NE SUITE 420
ATLANTA GA
30342-4763
US

IV. Provider business mailing address

2800 SCENIC DRIVE SUITE 4 BOX 77
BLUE RIDGE GA
30513
US

V. Phone/Fax

Practice location:
  • Phone: 404-252-5206
  • Fax: 404-252-1268
Mailing address:
  • Phone: 404-353-4137
  • Fax: 678-284-4076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number026793
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: