Provider Demographics
NPI:1124319173
Name:SCOGGINS, CHARLES M (HAD)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:M
Last Name:SCOGGINS
Suffix:
Gender:M
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8800 SE SUNNYSIDE RD
Mailing Address - Street 2:STE. 300-N
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015
Mailing Address - Country:US
Mailing Address - Phone:503-659-5115
Mailing Address - Fax:
Practice Address - Street 1:4 COOSAWATTEE AVE SW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-3500
Practice Address - Country:US
Practice Address - Phone:706-291-2496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAHADSOD0283237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist