Individual
DR. CHARLES LEO COSTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O
Contact information
Practice address
91 SAMMY MCGHEE BLVD, SUITE 101, JASPER, GA 30143-7703
(706) 253-6200
(706) 253-6276
Mailing address
91 SAMMY MCGHEE BLVD, SUITE 101, JASPER, GA 30143-7703
(706) 253-6200
(706) 253-6276
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
04754
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
85001880G
—
GA
Enumeration date
03/02/2007
Last updated
07/07/2008
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