Individual
MR. CHARLES EDWARD GENOE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COMS
Contact information
Practice address
1 FREEDOM WAY, UNIT 1B, AUGUSTA, GA 30904-6258
(706) 733-0188
Mailing address
1 FREEDOM WAY, UNIT 1B, AUGUSTA, GA 30904-6258
(706) 733-0188
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
1264
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1264
ACVREP
—
Enumeration date
12/13/2012
Last updated
12/13/2012
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