Healthcare Provider Details

I. General information

NPI: 1154427680
Provider Name (Legal Business Name): CHARLES G ALDRIDGE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1257 BRITTANY DR APT A
FLORENCE SC
29501-0249
US

IV. Provider business mailing address

1257 BRITTANY DR APT A
FLORENCE SC
29501-0249
US

V. Phone/Fax

Practice location:
  • Phone: 843-407-7334
  • Fax: 843-777-8705
Mailing address:
  • Phone: 843-407-7334
  • Fax: 843-777-8705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number186687
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN3457
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: