Healthcare Provider Details

I. General information

NPI: 1275612756
Provider Name (Legal Business Name): CHARLES A MCDILL D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12551 NORTH MAIN STREET
TRENTON GA
30752-1044
US

IV. Provider business mailing address

12551 NORTH MAIN STREET P.O. BOX 1044
TRENTON GA
30752-1044
US

V. Phone/Fax

Practice location:
  • Phone: 706-657-4777
  • Fax: 706-657-2034
Mailing address:
  • Phone: 706-657-4777
  • Fax: 706-657-2034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR007560
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: