Blache, Charlene Carla

Blache, Charlene Carla is an sole proprietor health care provider with primary practice located at 406 M Northside Drive , Valdosta GA 31602-1853. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Blache, Charlene Carla can be contacted via phone (229) 241-0059.

Contact Information

Primary practice address
406 M Northside Drive Valdosta GA 31602-1853
Phone: (229) 241-0059
Fax: (229) 241-2088
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 045728 Georgia

Profile Details

NPI number 1538139712
LBN Legal business name Blache, Charlene Carla
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 23rd, 2006
Last updated Sep 8th, 2015 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1538139712 NPPES
Georgia MEDICAID 000816593K
Georgia MEDICAID 000816593B
Georgia MEDICAID 000816593L

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