Lodge, Charles Gary

Lodge, Charles Gary is an individual health care provider with primary practice located at 6 Hospital Park , Moultrie GA 31768-6700. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Lodge, Charles Gary can be contacted via phone (229) 985-3320.

Contact Information

Primary practice address
6 Hospital Park Moultrie GA 31768-6700
Phone: (229) 985-3320
Fax: (229) 890-1282
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 024019 Georgia

Profile Details

NPI number 1366521205
LBN Legal business name Lodge, Charles Gary
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 2nd, 2006
Last updated Sep 1st, 2010 - about 15 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 1366521205 NPPES
Georgia MEDICAID 00296942B

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