DR. CHARLES GARY LODGE (NPI# 1366521205) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366521205 |
| Entity Type | Individual |
| Full Name | DR. CHARLES GARY LODGE |
| Credential | M.D. |
| Practice Address |
6 Hospital Park Moultrie GA 31768-6700 |
| Mailing Address |
Po Box 3037 Moultrie GA 31776-3037 |
| Practice Telephone | 2299853320 |
| Practice Fax Number | 2298901282 |
| Mailing Telephone | 2299853320 |
| Mailing Fax Number | 2298901282 |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2010-09-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 024019 | GA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 00296942B | 05 |
| Street Address |
6 HOSPITAL PARK |
| City | MOULTRIE |
| State | GA |
| Zip Code | 31768-6700 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336665371 | Colquitt Regional Infectious Disease LLC | Internal Medicine | 6 Hospital Park, Moultrie, GA 31768-6700 | 2017-08-22 |
| 1982124285 | Mary Catherine Seabrook Duskin | Family Medicine | 6 Hospital Park, Moultrie, GA 31768-6700 | 2017-06-27 |
| 1629485032 | Colquitt Regional Internal Medicine | Internal Medicine | 6 Hospital Park, Moultrie, GA 31768-6700 | 2014-07-17 |
| 1457791857 | Sedrick Bradley | Internal Medicine | 6 Hospital Park, Moultrie, GA 31768 | 2013-06-28 |
| 1639359342 | Jeong Sok Seo | Internal Medicine | 6 Hospital Park, Moultrie, GA 31768-6700 | 2007-11-09 |
| 1881758753 | Colquitt Regional Medical Center | Clinic/Center | 6 Hospital Park, Moultrie, GA 31768-6700 | 2006-12-21 |
| 1841369949 | Billy Ray Price II | Family Medicine | 6 Hospital Park, Moultrie, GA 31768-6700 | 2006-11-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356975452 | Zachary Schiffer | Specialist/Technologist | 3131 S Main Street, Moultrie, GA 31768 | 2020-02-27 |
| 1326697731 | Daisy Concierge Care | Nursing Care | 437 S. Morris Rd Lt 1, Moultrie, GA 31768 | 2019-09-09 |
| 1194208751 | Regina Mercer Ward | Nurse Practitioner | 1724 Villa Dr Sw, Moultrie, GA 31768 | 2018-09-10 |
| 1225473630 | Moultrie Orthodontics, P.C. | Clinic/Center | 12 Longleaf Office Park, Moultrie, GA 31768 | 2013-04-30 |
| 1497032239 | Freds Stores of Tennessee Inc | Pharmacy | 2601 South Main Street, Moultrie, GA 31768 | 2011-11-08 |
| 1821382672 | Colquitt Regional Ob/gyn, LLC | Obstetrics & Gynecology | 3 Sweet Bay Ct, Moultrie, GA 31768 | 2011-06-08 |
| 1568779809 | Shana Goodno | Nurse Practitioner | 207 31 St Ave Se, Moultrie, GA 31768 | 2010-09-08 |
| 1508177445 | Cherokee Rose Emergency Physicians | Emergency Medicine | 3131 South Main Street, Moultrie, GA 31768 | 2010-06-25 |
| 1023299963 | Hetal Patel | Counselor | 600 2nd St South East, Moultrie, GA 31768 | 2007-11-20 |
| 1720146756 | William C Byrd Inc | Assisted Living Facility | 498 5th Street Se, Moultrie, GA 31768 | 2006-12-04 |
| Find all providers in zip 31768 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376904201 | Swartzentruber Medical Services LLC | Family Medicine | 1335 4th St Sw, Moultrie, GA 31768-5818 | 2016-03-20 |
| 1366734683 | Convenient Care LLC | Family Medicine | 207 31st Ave Se, Moultrie, GA 31768-6703 | 2011-05-04 |
| 1417046517 | Brandi Weaver Warren | Family Medicine | 1 N Main St Ste 104, Moultrie, GA 31768-3878 | 2006-10-12 |
| 1497860134 | Nancy Lafuente | Family Medicine | 724 5th Ave Se, Moultrie, GA 31768-4911 | 2006-08-21 |
| 1609808179 | Robert O Spruill | Family Medicine | 8 Laurel Court, Moultrie, GA 31768 | 2006-07-07 |
| 1982124285 | Mary Catherine Seabrook Duskin | Family Medicine | 6 Hospital Park, Moultrie, GA 31768-6700 | 2017-06-27 |
| 1386189405 | Marco Hur | Family Medicine | 3131 S Main St, Moultrie, GA 31768-6925 | 2016-12-28 |
| 1225573348 | Michael Magat | Family Medicine | 3131 S Main St, Moultrie, GA 31768-6925 | 2016-12-28 |
| 1629510912 | Jessica Nicole Brumfield | Family Medicine | 1 Magnolia Ct, Moultrie, GA 31768-6764 | 2016-11-17 |
| 1962850396 | Colquitt Regional Medical Center | Family Medicine | 1 Magnolia Ct, Moultrie, GA 31768 | 2016-05-26 |
| Find all providers in MOULTRIE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.