Individual
DR. CHARLES GARY LODGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6 HOSPITAL PARK, MOULTRIE, GA 31768-6700
(229) 985-3320
(229) 890-1282
Mailing address
PO BOX 3037, MOULTRIE, GA 31776-3037
(229) 985-3320
(229) 890-1282
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
024019
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00296942B
—
GA
Enumeration date
11/02/2006
Last updated
09/01/2010
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