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General NPI Number Information
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NPI Number | 1518401306
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Entity Type | Individual
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Provider Name | CHARIESE MCCOY
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Gender | Female
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Dates
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Enumeration Date | 12/13/2016
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Last Update Date | 10/09/2018
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Provider Practice Location Address
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Address Line | 8400 ABERCORN ST 108-A
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City | SAVANNAH
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State | GA
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Zip | 31406-3425
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Country | US
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Telephone | 912-335-2636
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Fax | 912-330-1189
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Provider Business Mailing Address
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Address Line | 8400 ABERCORN ST 108-A
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City | SAVANNAH
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State | GA
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Zip | 31406
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Country | US
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Telephone | 912-844-1344
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Fax | 912-303-8649
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 025-R-1712
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License Number State | GA
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