MEDICARE: CHARLIE W DEVLIN MD

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	207RC0000X	Cardiovascular Disease Physician	12551	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316987860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLIE W DEVLIN MD

Provider Business Mailing Address
First Line	:	PO BOX 935722
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	31193-5722
Country	:	US
Telephone Number	:	843-792-6200
Fax Number	:

Provider Business Practice Location Address
First Line	:	114 GATEWAY CORPORATE BLVD STE 120
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29203-9785
Country	:	US
Telephone Number	:	803-409-7150
Fax Number	:	803-409-7158

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	08/25/2021

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