Individual
CHARLES JEFFREY SIDLOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
958 JOE FRANK HARRIS PKWY SE BLDG A, SUITE 106, CARTERSVILLE, GA 30120-2175
(770) 386-1389
(770) 386-4894
Mailing address
958 JOE FRANK HARRIS PKWY SE BLDG A, SUITE 106, CARTERSVILLE, GA 30120-2175
(770) 386-1389
(770) 386-4894
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
POD000560
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000333803A
—
GA
Enumeration date
03/23/2006
Last updated
12/19/2012
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