MEDICARE: DR. CHARLES GRAY HAISLIP DO

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	1842	WV

General Provider Information

NPI Number	:	1184613994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES GRAY HAISLIP DO

Provider Business Mailing Address
First Line	:	300 W HOSPITAL RD
Second Line	:
City	:	FORT GORDON
State	:	GA
Zip	:	30905-5741
Country	:	US
Telephone Number	:	706-787-5811
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 W HOSPITAL RD
Second Line	:
City	:	FORT GORDON
State	:	GA
Zip	:	30905-5741
Country	:	US
Telephone Number	:	706-787-5811
Fax Number	:

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

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	11/17/2025

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