Active NPI
Charles Gary Lodge, M.D.
- Family Medicine Physician
- Moultrie, GA
National Provider Identifier
1366521205
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 024019
- Practice address
- 6 Hospital Park
Moultrie, GA 31768-6700 - Phone
- (229) 985-3320
- Fax
- (229) 890-1282
- NPI assigned
- Nov 2, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 024019 | GA | Primary |
Addresses
Primary practice location
6 Hospital Park
Moultrie, GA 31768-6700
Mailing address
PO Box 3037
Moultrie, GA 31776-3037
Phone (229) 985-3320
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00296942B | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 024019 | GA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Colquitt Regional Medical Center | Family Medicine | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Rural Health Clinic/Center
- Moultrie, GA
- NPI 1881758753
Family Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162425600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1283299200000",
"number": "1366521205",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3037",
"city": "MOULTRIE",
"state": "GA",
"postal_code": "317763037",
"telephone_number": "229-985-3320",
"fax_number": "229-890-1282"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6 HOSPITAL PARK",
"city": "MOULTRIE",
"state": "GA",
"postal_code": "317686700",
"telephone_number": "229-985-3320",
"fax_number": "229-890-1282"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LODGE",
"first_name": "CHARLES",
"middle_name": "GARY",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-02",
"last_updated": "2010-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "GA",
"license": "024019",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00296942B",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Moultrie, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.