Individual
DOMONIQUE CHARLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
744 1ST ST, MACON, GA 31201
(478) 633-7600
Mailing address
744 1ST ST, MACON, GA 31201-6840
(478) 633-7600
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
081118
GA
Other
Enumeration date
05/20/2015
Last updated
08/21/2018
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