Provider Demographics
NPI:1306891395
Name:LEEWOOD, CHARLES T (DO)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:T
Last Name:LEEWOOD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5501 ABERCORN ST
Mailing Address - Street 2:C172
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6911
Mailing Address - Country:US
Mailing Address - Phone:912-232-9700
Mailing Address - Fax:912-232-9701
Practice Address - Street 1:5356 REYNOLDS ST
Practice Address - Street 2:201
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6016
Practice Address - Country:US
Practice Address - Phone:912-819-8187
Practice Address - Fax:912-232-9701
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2015-01-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036-115155207P00000X
GA061117207P00000X
SC1186207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG61117Medicaid
GA440010727BMedicaid
GA440010727CMedicaid
GA440010727AMedicaid
GA440010727AMedicaid
GA511I930463Medicare PIN