Individual
MRS. CHARLENE CARLA BLACHE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
406 M NORTHSIDE DRIVE, VALDOSTA, GA 31602-1853
(229) 241-0059
(229) 241-2088
Mailing address
406 M NORTHSIDE DRIVE, VALDOSTA, GA 31602-1853
(229) 241-0059
(229) 241-2088
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
045728
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000816593B
—
GA
05
—
000816593K
—
GA
05
—
000816593L
—
GA
Enumeration date
01/23/2006
Last updated
09/08/2015
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