Healthcare Provider Details

I. General information

NPI: 1730074915
Provider Name (Legal Business Name): MR. CHARLES EDWARD BRETT JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2025
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 SILVER HILLS DR
JACKSONVILLE NC
28546-8749
US

IV. Provider business mailing address

257 SILVER HILLS DR
JACKSONVILLE NC
28546-8749
US

V. Phone/Fax

Practice location:
  • Phone: 757-285-3328
  • Fax:
Mailing address:
  • Phone: 757-285-3328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Y00000X
TaxonomyHealth Information Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: