Healthcare Provider Details

I. General information

NPI: 1396789897
Provider Name (Legal Business Name): CHARLES MCCORD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3345 HIGHWAY 34 E SUITE 102
SHARPSBURG GA
30277-3563
US

IV. Provider business mailing address

PO BOX 71879
NEWNAN GA
30271-1879
US

V. Phone/Fax

Practice location:
  • Phone: 770-252-5290
  • Fax: 770-252-5295
Mailing address:
  • Phone: 770-252-5290
  • Fax: 770-252-5295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number039406
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: