Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
DR. CHARLES B IDOM JR., M.D., FACS
Deactivated Sole ProprietorDR. CHARLES B IDOM JR., M.D., FACS is a Urology healthcare provider located in DALTON, Georgia. NPI 1316943210 is deactivated in the NPPES registry. Verify at CMS.
Urology · DALTON, GA
This NPI has been deactivated.
The record was deactivated on March 16, 2006.
Deactivated NPIs are no longer valid for billing or credentialing. The provider may have retired, changed practice status, or had their NPI administratively deactivated.
Verify current licensure status with the NPPES NPI Registry or the relevant state medical board before relying on this record.
Registration Details
- NPI Number
- 1316943210
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Jun 24, 2005 (0.72602739726027 yrs)
- Last Updated
- Sep 11, 2017
- Deactivated
- Mar 16, 2006
- License
-
050482 (GA)
- Sole Proprietor
- Yes
Practice Information
- Address
-
1434 BROADRICK DRDALTON, GA, 307203009Browse GA providers · Browse ZIP 30720
- Phone
- 7062785961
- Fax
- 7062750280
- Primary Specialty
-
Urology
208800000X
Other Urology Providers in DALTON, GA
| Name | Credential | NPI |
|---|---|---|
| DR. JOSEPH ANTHONY VEYS | MD | 1861464208 |
| DR. PAUL EDWARD HENSON JR. | MD | 1295200426 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.