MEDICARE: DR. CHARLES WHITLEY EMERSON III M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	22535	AL

General Provider Information

NPI Number	:	1124224753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES WHITLEY EMERSON III M.D.

Provider Business Mailing Address
First Line	:	4300 N POINT PKWY STE 300
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30022-4102
Country	:	US
Telephone Number	:	770-442-1911
Fax Number	:	770-442-0306

Provider Business Practice Location Address
First Line	:	1612 HIGHWAY 78 EAST
Second Line	:	SUITE 100
City	:	OXFORD
State	:	AL
Zip	:	36203-5862
Country	:	US
Telephone Number	:	256-835-4756
Fax Number	:	256-831-5736

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2007
Last Update Date	:	08/31/2023

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