Charlie Van Diviere LTD
Organization Active NPI Durable Medical Equipment & Medical Supplies · Tignall, GA
NPI 1962568626 · NPPES record last updated Aug 6, 2008
Key facts
- NPI
- 1962568626
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Durable Medical Equipment & Medical Supplies 332B00000X
- License
- 00462393 A&B (GA)
- Legal business name
- CHARLIE VAN DIVIERE LTD
- Practice address
- 357 Boyce Guin Rd
Tignall, GA 30668-3639 - Phone
- (706) 285-2073
- Fax
- (706) 285-2076
- NPI assigned
- Dec 28, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Chas. L. Van Diviere Jr.
- Title
- President
- Phone
- (706) 285-2073
Corporate family (same tax ID) 1
National Provider Directory
- Tax ID family
- Chas Van Diviere LTD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | 00462393 A&B | GA | Yes |
Addresses
Primary practice location
357 Boyce Guin Rd
Tignall, GA 30668-3639
Mailing address
357 Boyce Guin Rd
Tignall, GA 30668-3639
Phone (706) 285-2073
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00462393A | Medicaid | GA | |
| 00462393B | Medicaid | GA |
Other names
- Charlie's Discount Medical
Other providers in Tignall, GA
- Tena Austin Blakey
- Chas Van Diviere LTD
- Country Manor Personal Care Home, Inc
- David Manning Stubbs
- The Armour House
- Tignall Assisted Living, LLC
All providers in Tignall, GA · Durable Medical Equipment & Medical Supplies in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 6, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.