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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

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