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Dr. Charles Edward Middleton III

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NPI Number Detailed Information

Provider Information:

Name: Dr. Charles Edward Middleton III
Gender: M
Provider License Number If Given: 17155

NPI Information:

NPI: 1326047861
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 7/18/2005

Last Update Date: 7/8/2007

Provider Business Mailing Address:

Address: 4869 SPRING RIDGE DR
Columbus, GA 31909
Phone Number: 7065755671
Fax Number:

Provider Business Practice Location Address:

Address: 1061 HARMON AVE DEPARTMENT ORAL AND MAXILLOFACIAL SURGERY
Ft Stewart, GA 31314
Phone Number: 9124356248
Fax Number:

Provider Taxonomy:

Primary: 1223S0112X
Secondary (if any):
State: GA

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