Organization
COSTER CARE
Active
Other names
Ball Ground Family Practice,P.C.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES LEO COSTER DO (PHYSICIAN)
(706) 253-6200
Entity
Organization
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
045754
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000797945A
—
GA
05
—
000797948A
—
GA
Enumeration date
07/29/2008
Last updated
10/06/2008
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