Provider Demographics
NPI:1063576288
Name:MCCLURE, CHARLES GETTYS (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:GETTYS
Last Name:MCCLURE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:818 SAINT SEBASTIAN WAY 408
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2654
Mailing Address - Country:US
Mailing Address - Phone:706-722-9075
Mailing Address - Fax:706-722-7049
Practice Address - Street 1:1348 WALTON WAY
Practice Address - Street 2:SUITE 4500
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-5104
Practice Address - Country:US
Practice Address - Phone:706-722-8817
Practice Address - Fax:706-722-3956
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2015-10-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA0176302084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000110261FMedicaid
SC906737Medicaid
GA000110261FMedicaid