Healthcare Provider Details

I. General information

NPI: 1235504192
Provider Name (Legal Business Name): CHARTER INPATIENT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2015
Last Update Date: 08/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CHARTER BLVD
MACON GA
31210-4831
US

IV. Provider business mailing address

13737 NOEL RD #1600
DALLAS TX
75240-1331
US

V. Phone/Fax

Practice location:
  • Phone: 478-757-6200
  • Fax:
Mailing address:
  • Phone: 954-838-2371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GREGORY J BYRNE
Title or Position: PRESIDENT
Credential: MD
Phone: 954-838-2371