MEDICARE: DR. CHARLES SAMUEL FILLINGANE 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	207P00000X	Emergency Medicine Physician	11114	MS
2	207Q00000X	Family Medicine Physician	11114	MS

General Provider Information

NPI Number	:	1346261195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES SAMUEL FILLINGANE DO

Provider Business Mailing Address
First Line	:	1021 N FLOWOOD DR
Second Line	:
City	:	FLOWOOD
State	:	MS
Zip	:	39232-9533
Country	:	US
Telephone Number	:	601-664-2424
Fax Number	:	601-664-6675

Provider Business Practice Location Address
First Line	:	27 LAKE FORGETFUL APT 528
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39402-8275
Country	:	US
Telephone Number	:	601-906-9389
Fax Number	:

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	10/08/2019

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