Healthcare Provider Details

I. General information

NPI: 1609911262
Provider Name (Legal Business Name): DR. CHARLES ALLEN TIGNER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 SOUTH COURT SQUARE
GREENVILLE GA
30222
US

IV. Provider business mailing address

P.O. BOX 69 121 SOUTH COURT SQUARE
GREENVILLE GA
30222
US

V. Phone/Fax

Practice location:
  • Phone: 706-672-4221
  • Fax: 706-672-0586
Mailing address:
  • Phone: 706-672-4221
  • Fax: 706-672-0586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH017676
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: