Healthcare Provider Details

I. General information

NPI: 1174557268
Provider Name (Legal Business Name): CHARLES OWEN OSHAUGHNESSY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 INLET AVE
TYBEE ISLAND GA
31328
US

IV. Provider business mailing address

PO BOX 2678
TYBEE ISLAND GA
31328
US

V. Phone/Fax

Practice location:
  • Phone: 912-786-8866
  • Fax: 912-786-8632
Mailing address:
  • Phone: 912-786-8866
  • Fax: 912-786-8632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number033420
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number033420
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: