Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 040559 | GA |
NPI | 1134132657 |
---|---|
Provider Name | Charles Augustin Staley |
First Address | Atlanta, GA 30322-1013 |
Second Address | Atlanta, GA 30322-1013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 06/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000664331A | (05) | GA |
1299416 | UNITED HEALTHCARE (01) | GA |
542386 | BCBS (01) | GA |
581116 | US HEALTHCARE (01) | GA |
910000107 | RAILROAD MEDICARE (01) | GA |
F34710001 | (02) | GA |