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General NPI Number Information
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NPI Number | 1023058906
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Entity Type | Individual
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Provider Name | CHARLES THOMAS INGRAM JR. MD
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Gender | Male
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1077 S MAIN
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City | MADISON
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State | GA
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Zip | 30650
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Country | US
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Telephone | 706-342-1667
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 72483
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City | MARIETTA
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State | GA
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Zip | 30007-2483
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Country | US
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Telephone | 770-578-1800
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Fax | 770-578-6168
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 19704
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License Number State | GA
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