Provider Demographics
NPI:1811987209
Name:EMELIFE, CHARMAINE I (MD)
Entity type:Individual
Prefix:
First Name:CHARMAINE
Middle Name:I
Last Name:EMELIFE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-3433
Mailing Address - Country:US
Mailing Address - Phone:404-761-0819
Mailing Address - Fax:404-761-0819
Practice Address - Street 1:1275 CLEVELAND AVENUE
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344
Practice Address - Country:US
Practice Address - Phone:404-761-0819
Practice Address - Fax:404-761-0819
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054486174400000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA157444445AMedicaid
GA157444445AMedicaid
GA39BDCKMMedicare PIN