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General NPI Number Information
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NPI Number | 1295904456
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Entity Type | Organization
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Legal Business Name | CHARLES L. MCCORD, M.D., LLC.
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Dates
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Enumeration Date | 02/21/2008
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Last Update Date | 02/21/2008
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Provider Practice Location Address
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Address Line | 3345 HIGHWAY 34 E SUITE 102
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City | SHARPSBURG
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State | GA
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Zip | 30277-3563
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Country | US
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Telephone | 770-252-5290
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Fax | 770-252-5295
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Provider Business Mailing Address
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Address Line | 3345 HIGHWAY 34 E SUITE 102
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City | SHARPSBURG
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State | GA
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Zip | 30277-3563
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Country | US
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Telephone | 770-252-5290
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Fax | 770-252-5295
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Authorized Official
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Title or Position | OB/GYN
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Name | CHARLES MCCORD
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Credential | M.D. LLC
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Telephone | 770-252-5290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 039409
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License Number State | GA
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