CHARLES DANIEL PROCTER SR. (NPI# 1457369258) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1457369258 |
Entity Type | Individual |
Full Name | CHARLES DANIEL PROCTER SR. |
Other Name | C DAN PROCTER SR. |
Credential | MD |
Practice Address |
725 Jesse Jewell Pkwy Se Gainesville GA 30501-3834 |
Mailing Address |
Po Box 658 Gainesville GA 30503-0658 |
Practice Telephone | 7705340110 |
Practice Fax Number | 7705342555 |
Mailing Telephone | 7707181122 |
Mailing Fax Number | 7705357445 |
Enumeration Date | 2006-08-04 |
Last Update Date | 2019-03-07 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
035736 | GA | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
GA | 000502873K | 05 | |
GA | WELLCARE | 1708262 | 01 |
GA | AMERIGROUP | 01338970 | 01 |
GA | WELLCARE | 544229 | 01 |
GA | 000502873S | 05 | |
GA | BCBS | 592947 | 01 |
GA | 000502873I | 05 | |
GA | 000502873J | 05 | |
GA | 000502873M | 05 | |
GA | 000502873R | 05 | |
GA | 000502873T | 05 |
Address | Telephone Number | Fax Number |
---|---|---|
1270 Friendship Rd, Braselton, GA 305175630 | 6782074070 | 6782074071 |
500 Medical Center Blvd Ste 310, Lawrenceville, GA 300463332 | 6782074000 | 7705342555 |
631 Professional Dr Ste 240, Lawrenceville, GA 300463397 | 6782074000 | 7705342555 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1598780488 | Charles D Procter Jr. | Surgery | 3193 Howell Mill Rd Nw Ste 125, Atlanta, GA 30327-2100 | 2006-07-13 |
Street Address |
725 JESSE JEWELL PKWY SE |
City | GAINESVILLE |
State | GA |
Zip Code | 30501-3834 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1861495491 | Priscilla Ruth Strom | Surgery | 725 Jesse Jewell Pkwy Se, Gainesville, GA 30501-3834 | 2005-05-27 |
1578040523 | Jeffrey Scott Wieseman | Registered Nurse | 725 Jesse Jewell Pkwy Se, Gainesville, GA 30501 | 2018-07-23 |
1164916581 | Anny Sosebee | Nurse Practitioner | 725 Jesse Jewell Pkwy Se, Gainesville, GA 30501 | 2018-06-19 |
1538653829 | D'anna Cain | Nurse Practitioner | 725 Jesse Jewell Pkwy Se, Gainesville, GA 30501 | 2018-06-19 |
1518471044 | Cheryl Lynn Thorsten | Nurse Practitioner | 725 Jesse Jewell Pkwy Se, Gainesville, GA 30501-3834 | 2017-11-20 |
1669915930 | Abigail Grace Bell | Dietitian, Registered | 725 Jesse Jewell Pkwy Se, Gainesville, GA 30501-3834 | 2016-11-18 |
1710431226 | Oteia Keion Morris | Nurse Practitioner | 725 Jesse Jewell Pkwy Se, Gainesville, GA 30501 | 2016-08-12 |
1588015473 | Aliah D Sapp | Nurse Practitioner | 725 Jesse Jewell Pkwy Se, Gainesville, GA 30501-3834 | 2016-06-22 |
1821447434 | Michelle Marie Ladewig | Nurse Practitioner | 725 Jesse Jewell Pkwy Se, Gainesville, GA 30501-3834 | 2016-06-06 |
1770944373 | Kathryn Martin Weeks | Nurse Practitioner | 725 Jesse Jewell Pkwy Se, Gainesville, GA 30501-3834 | 2016-03-10 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1437782851 | Madison Raye Huth | Physician Assistant | 743 Spring Street Se, Gainesville, GA 30501 | 2020-02-13 |
1205487659 | Grace M Walker Brown | Nurse Practitioner | 592 Medical Park Dr., Suite A, Gainesville, GA 30501 | 2019-09-26 |
1174086987 | Nayab Ahmed | Student in an Organized Health Care Education/Training Program | 743 Spring Street, Suite 710, Gainesville, GA 30501 | 2019-04-09 |
1154881118 | Ryan D Berry | Student in an Organized Health Care Education/Training Program | 734 Spring St Se Ste 710, Gainesville, GA 30501 | 2019-03-24 |
1609336304 | Harper E Niver | Student in an Organized Health Care Education/Training Program | 743 Spring St., Suite 710, Gainesville, GA 30501 | 2019-03-20 |
1508336173 | Bradee Burrell Aderholt | Nurse Practitioner | 663 Lanier Park Drive, Gainesville, GA 30501 | 2018-11-27 |
1578068359 | Soammy Liz Matias | Chiropractor | 961 Green Street, Gainesville, GA 30501 | 2018-03-26 |
1811496896 | Matthew Brown | Speech-Language Pathologist | 500 Spring St. Se Suite 101, Gainesville, GA 30501 | 2018-02-06 |
1346769825 | Dr. Skeete & Associates of North Georgia, P.C. | Optometrist | 150 Pearl Nix Parkway, Suite D3a, Gainesville, GA 30501 | 2017-09-15 |
1932624723 | M & B Imaging, PC | Radiology | 1640 Jesse Jewell Pkwy Se Ste 2, Gainesville, GA 30501 | 2017-08-14 |
Find all providers in zip 30501 |
Taxonomy Code | 2086S0129X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Surgery |
Specialization | Vascular Surgery |
A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1740468396 | Cardiac & Vascular Surgery Specialist, Pa | Surgery | 1121 Nw 64th Terr., Ste A, Gainesville, FL 32605 | 2008-02-06 |
1790797421 | Anthony Vincent Caggiano Sr. | Surgery | 1100 Nw 8th Ave, Suite B, Gainesville, FL 32601-2916 | 2006-08-12 |
1730479247 | Raquel Camille Jones | Surgery | 725 Jesse Jewell Pkwy Se, Gainesville, GA 30501-3834 | 2011-04-18 |
1801109368 | Niraj Parikh | Surgery | 200 S Enota Dr Ne Ste 360, Gainesville, GA 30501-3466 | 2010-07-26 |
1609040401 | Dev Mangalat | Surgery | 725 Jesse Jewell Pkwy Se, Gainesville, GA 30501-3834 | 2008-04-14 |
1043407851 | Robert L R Wesly M D Ph D P A | Surgery | 2251 Nw 41st St, Suite E, Gainesville, FL 32606-7498 | 2007-09-26 |
1548394455 | Robert L R Wesly | Surgery | 1143 Nw 64th Ter, Gainesville, FL 32605-4218 | 2007-03-15 |
1972530822 | Timothy C Flynn | Surgery | 1600 Sw Archer Rd, Gainesville, FL 32610-3003 | 2006-06-27 |
1639118532 | Scott A Berceli | Surgery | 1600 Sw Archer Rd, Gainesville, FL 32610-3003 | 2006-06-06 |
1689671364 | Charles Bruce Moomey Jr. | Surgery | 725 Jesse Jewell Pkwy Se, Gainesville, GA 30501-3834 | 2005-07-07 |
Find all providers in GAINESVILLE |
City | GAINESVILLE |
Zip Code | 30501 |
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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.