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General NPI Number Information
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NPI Number | 1477819761
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Entity Type | Organization
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Legal Business Name | FOCUS.MD-SC 1002, LLC
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Dates
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Enumeration Date | 04/11/2012
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Last Update Date | 04/11/2012
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Provider Practice Location Address
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Address Line | 8045 PROVIDENCE RD SUITE 325
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City | CHARLOTTE
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State | NC
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Zip | 28277-8745
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Country | US
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Telephone | 704-804-1901
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Fax | 833-731-3760
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Provider Business Mailing Address
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Address Line | 10 ENTERPRISE BLVD SUITE 202
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City | GREENVILLE
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State | SC
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Zip | 29615-6301
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Country | US
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Telephone | 864-248-6393
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Fax | 866-731-3760
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLES THOMAS HUMPHRIES
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Credential | MD
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Telephone | 704-804-1901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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