Individual
EMMANUELLE C CHARLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
715 QUEEN CITY PKWY, GAINESVILLE, GA 30501-4348
(770) 531-5115
(770) 531-5116
Mailing address
3945 LAWRENCEVILLE HWY NW, LILBURN, GA 30047-2817
(770) 910-2377
(770) 910-2377
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
005291
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003116541B
—
GA
05
—
003116541C
—
GA
05
—
003116541D
—
GA
05
—
003116541E
—
GA
05
—
003116541G
—
GA
Enumeration date
07/30/2009
Last updated
04/04/2014
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