Provider Demographics
NPI:1053386508
Name:HARDEN, CHARLES M JR (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:M
Last Name:HARDEN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:130 N GROSS RD STE 201
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31548-6277
Mailing Address - Country:US
Mailing Address - Phone:912-729-2795
Mailing Address - Fax:912-729-4117
Practice Address - Street 1:130 N GROSS RD STE 201
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-6277
Practice Address - Country:US
Practice Address - Phone:912-729-2795
Practice Address - Fax:912-729-4117
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-20
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044930207PE0004X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA206395OtherBLUE CROSS
GA000799345DMedicaid
D79466Medicare UPIN
GA000799345DMedicaid