Healthcare Provider Details

I. General information

NPI: 1942503222
Provider Name (Legal Business Name): CHARLES R. ABSHER10
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2010
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 BALFOUR DR
ARCHDALE NC
27263-3117
US

IV. Provider business mailing address

284 EXECUTIVE PARK DR. SUITE 100
CONCORD NC
28025-1894
US

V. Phone/Fax

Practice location:
  • Phone: 800-422-8034
  • Fax:
Mailing address:
  • Phone: 704-939-1118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: