Healthcare Provider Details

I. General information

NPI: 1760336309
Provider Name (Legal Business Name): MR. CAREY CHARLESTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 02/23/2026
Certification Date: 02/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22500 FEDERAL AVE
WARREN MI
48089-5304
US

IV. Provider business mailing address

11439 MAXWELL AVE
WARREN MI
48089-2582
US

V. Phone/Fax

Practice location:
  • Phone: 313-477-2226
  • Fax:
Mailing address:
  • Phone: 313-477-2226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: