Individual
CHARLES AUGUSTIN STALEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1365 CLIFTON RD NE, BLDG C, ATLANTA, GA 30322-1013
(404) 778-3301
Mailing address
1365 CLIFTON RD NE, BLDG C, ATLANTA, GA 30322-1013
(404) 778-3301
Taxonomy
Speciality
Code
Description
License number
State
2086X0206X
Surgical Oncology Physician
Primary
040559
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000664331A
—
GA
01
—
1299416
UNITED HEALTHCARE
GA
01
—
542386
BCBS
GA
01
—
581116
US HEALTHCARE
GA
01
—
910000107
RAILROAD MEDICARE
GA
Enumeration date
08/14/2006
Last updated
09/06/2011
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