Healthcare Provider Details

I. General information

NPI: 1053385450
Provider Name (Legal Business Name): CHARLES H SYKES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 HOSPITAL BLVD
ROSWELL GA
30076-4915
US

IV. Provider business mailing address

PO BOX 116414
ATLANTA GA
30368-6414
US

V. Phone/Fax

Practice location:
  • Phone: 770-751-2500
  • Fax:
Mailing address:
  • Phone: 770-779-2172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number037397
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: