Individual
MISS CHARLOTTE AMELIA EBNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
2878 FIVE FORKS TRICKUM RD, LAWRENCEVILLE, GA 30044-5896
(678) 344-8700
(678) 344-8600
Mailing address
2878 FIVE FORKS TRICKUM ROAD, LAWRENCEVILLE, GA 30044
(678) 344-8700
(678) 344-8600
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
069580
GA
207Q00000X
Family Medicine Physician
1390
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
013906
—
SC
01
—
P01117581
RAILROAD MEDICARE
SC
Enumeration date
06/14/2010
Last updated
02/03/2017
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