MEDICARE: DR. CHARLES W WYBLE JR. 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	2086S0129X	Vascular Surgery Physician	056938	GA

General Provider Information

NPI Number	:	1932176377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES W WYBLE JR. MD

Provider Business Mailing Address
First Line	:	60 CHASTAIN CENTER BLVD NW STE 66
Second Line	:
City	:	KENNESAW
State	:	GA
Zip	:	30144-5598
Country	:	US
Telephone Number	:	770-423-0595
Fax Number	:	678-391-5055

Provider Business Practice Location Address
First Line	:	61 WHITCHER STREET NE
Second Line	:	SUITE 2100
City	:	MARIETTA
State	:	GA
Zip	:	30060-1179
Country	:	US
Telephone Number	:	770-423-0595
Fax Number	:	770-423-0598

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

Provider Enumeration Date	:	03/03/2006
Last Update Date	:	09/19/2025

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