Individual
DR. CHARLES L OGBURN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
330 HOSPITAL DR, BLDG C, STE 200, MACON, GA 31217-3899
(478) 745-1191
(478) 752-3869
Mailing address
330 HOSPITAL DR, BLDG C, STE 200, MACON, GA 31217-3899
(478) 745-1191
(478) 752-3869
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
019576
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00163622A
—
GA
Enumeration date
01/31/2006
Last updated
12/15/2009
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