Provider Demographics
NPI:1174517502
Name:GALEA, CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:GALEA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CARMEL
Other - Middle Name:
Other - Last Name:GALEA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:615-A PENDLETON STREET
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-4724
Mailing Address - Country:US
Mailing Address - Phone:912-548-0710
Mailing Address - Fax:912-548-0071
Practice Address - Street 1:615-A PENDLETON STREET
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-4724
Practice Address - Country:US
Practice Address - Phone:912-548-0710
Practice Address - Fax:912-548-0071
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055229207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA682692434CMedicaid
GA682692434CMedicaid
GAI22983Medicare UPIN