Provider Demographics
NPI:1871362582
Name:REDD, CHARLES
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:REDD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 GENTIAN BLVD STE 8A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-5639
Mailing Address - Country:US
Mailing Address - Phone:706-718-7964
Mailing Address - Fax:470-552-2767
Practice Address - Street 1:3100 GENTIAN BLVD STE 8A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-5639
Practice Address - Country:US
Practice Address - Phone:706-718-7964
Practice Address - Fax:470-552-2767
Is Sole Proprietor?:No
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW011605104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker