Healthcare Provider Details

I. General information

NPI: 1417548660
Provider Name (Legal Business Name): CHARLES DOUGLAS STUTESMAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2021
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 NEW LEICESTER HWY
ASHEVILLE NC
28806-1048
US

IV. Provider business mailing address

PO BOX 100181
COLUMBIA SC
29202-3141
US

V. Phone/Fax

Practice location:
  • Phone: 852-202-5200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001012185
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: