Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PE0004X | Emergency Medical Services | 044930 | GA |
Y | 208D00000X | General Practice Physician | 044930 | GA |
NPI | 1053386508 |
---|---|
Provider Name | Dr. Charles M Harden JR. |
First Address | Helena, GA 31037-4038 |
Second Address | Brunswick, GA 31525-7921 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2006 |
Last Update Date | 15/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000799345D | (05) | GA |
206395 | BLUE CROSS (01) | GA |
D79466 | (02) |