MEDICARE: CHARLES FRANCIS FENTON III DPM

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	213E00000X	Podiatrist	POD000466	GA

General Provider Information

NPI Number	:	1942202783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES FRANCIS FENTON III DPM

Provider Business Mailing Address
First Line	:	5505 PEACHTREE DUNWOODY RD NE
Second Line	:	SUITE 420
City	:	ATLANTA
State	:	GA
Zip	:	30342-1705
Country	:	US
Telephone Number	:	404-843-0090
Fax Number	:	404-843-1008

Provider Business Practice Location Address
First Line	:	5505 PEACHTREE DUNWOODY RD NE
Second Line	:	SUITE 420
City	:	ATLANTA
State	:	GA
Zip	:	30342-1705
Country	:	US
Telephone Number	:	404-843-0090
Fax Number	:	404-843-1008

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	01/14/2011

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