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Charles W Ficco
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NPI Number Detailed Information
Provider Information:
| Name: | Charles W Ficco |
| Gender: | M |
| Provider License Number If Given: | OPT01583 |
NPI Information:
| NPI: | 1841284346 |
| Entity Type (Individual or Organization): |
1-ind |
| Enumeration Date: | 9/12/2005 |
| Last Update Date: | 10/22/2019 |
Provider Business Mailing Address:
| Address: | 1300 PEACHTREE INDUSTRIAL BLVD STE 1201 Suwanee, GA 30024 |
| Phone Number: | 6783812020 |
| Fax Number: | 6783812015 |
Provider Business Practice Location Address:
| Address: | 970 SANDERS RD STE 100 Cumming, GA 30041 |
| Phone Number: | 6783812020 |
| Fax Number: | 6783812015 |
Provider Taxonomy:
| Primary: | 152W00000X |
| Secondary (if any): | |
| State: | GA |
