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General NPI Number Information
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NPI Number | 1356318679
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Entity Type | Individual
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Provider Name | CHARLES A GERTLER P.A.-C
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Gender | Male
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Dates
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Enumeration Date | 03/06/2006
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Last Update Date | 01/07/2010
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Provider Practice Location Address
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Address Line | 3675 J DEWEY GRAY CIRCLE SUITE 300
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City | AUGUSTA
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State | GA
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Zip | 30909-1868
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Country | US
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Telephone | 706-863-9595
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Fax | 706-860-7124
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Provider Business Mailing Address
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Address Line | PO BOX 3726
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City | AUGUSTA
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State | GA
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Zip | 30914-3726
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Country | US
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Telephone | 706-863-9595
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Fax | 706-860-7124
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 000857
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License Number State | GA
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