Organization
CHARLIE VAN DIVIERE LTD
Active
Other names
Charlie's Discount Medical
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHAS. L. VAN DIVIERE JR. (PRESIDENT)
(706) 285-2073
Entity
Organization
Contact information
Practice address
357 BOYCE GUIN RD, TIGNALL, GA 30668-3639
(706) 285-2073
(706) 285-2076
Mailing address
357 BOYCE GUIN RD, TIGNALL, GA 30668-3639
(706) 285-2073
(706) 285-2076
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
00462393 A&B
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00462393A
—
GA
05
—
00462393B
—
GA
Enumeration date
12/28/2006
Last updated
08/06/2008
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