Individual provider Active NPI

Charles Leo Coster, D.O

  • Family Medicine Physician
  • Jasper, GA
National Provider Identifier
1124157722
Registry record updated Jul 7, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
04754 Issued in GA
Practice address
91 Sammy McGhee Blvd
Suite 101
Jasper, GA 30143-7703
Phone
(706) 253-6200
Fax
(706) 253-6276
NPI assigned
Mar 2, 2007
Last updated
Jul 7, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 04754 GA Primary

Addresses

Primary practice location

91 Sammy McGhee Blvd
Suite 101
Jasper, GA 30143-7703

Mailing address

91 Sammy McGhee Blvd
Suite 101
Jasper, GA 30143-7703
Phone (706) 253-6200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, NC2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040525000047 GA Practitioner - Family Practice 5991796484 Reassigns benefits to 1 organization
I20260515003247 NC Practitioner - Family Practice 5991796484 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Kansas City University of Med & Biosciences, College of Osteo Med, 1982
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

146 Hwy 64 E
Hayesville, NC 28904-7300

975 E 3Rd St
Box 159
Chattanooga, TN 37403-2163

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
04754GAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wellstreet of Georgia PC CurrentSince Mar 23, 2023 Accepting new patients
Chatuge Regional Hospital Inc Past Accepting new patients
Chatuge Regional Hospital Inc Past Accepting new patients
Ball Ground Family Practice,P.C. Family Medicine PastSince Feb 17, 2004 Accepting new patients

Locations

2292 Peachtree Rd NW
Atlanta, GA 30309
Phone (404) 382-9941

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1215388800000",
    "number": "1124157722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "91 SAMMY MCGHEE BLVD",
            "address_2": "SUITE 101",
            "city": "JASPER",
            "state": "GA",
            "postal_code": "301437703",
            "telephone_number": "706-253-6200",
            "fax_number": "706-253-6276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "91 SAMMY MCGHEE BLVD",
            "address_2": "SUITE 101",
            "city": "JASPER",
            "state": "GA",
            "postal_code": "301437703",
            "telephone_number": "706-253-6200",
            "fax_number": "706-253-6276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTER",
        "first_name": "CHARLES",
        "middle_name": "LEO",
        "name_prefix": "Dr.",
        "credential": "D.O",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-02",
        "last_updated": "2008-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "04754",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jasper, GA

Sources for this page

Verify at the official NPI Registry.