Individual
DR. CHARLES M MENDENHALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
425 3RD AVE, STE 50, ALBANY, GA 31701-1955
(229) 883-0717
(229) 312-2257
Mailing address
425 3RD AVE, STE 50, ALBANY, GA 31701-1955
(229) 883-0717
(229) 312-2257
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
24842
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00266252A
—
GA
01
—
122061
PEACH STATE
—
01
—
320000060
RAILROAD MEDICARE
—
01
—
341228
WELLCARE
—
01
—
CL3407
RAILROAD MEDICARE GROUP
—
01
—
GRP754
MEDICARE GROUP
—
Enumeration date
11/21/2005
Last updated
12/14/2007
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