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General NPI Number Information
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NPI Number | 1790364206
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Entity Type | Individual
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Provider Name | CHARLES OWEN NATION III MD
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Gender | Male
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Dates
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Enumeration Date | 04/03/2021
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 323 E CHESTNUT ST
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City | LOUISVILLE
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State | KY
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Zip | 40202-1823
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Country | US
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Telephone | 843-325-4165
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Fax |
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Provider Business Mailing Address
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Address Line | 3921 LELAND RD
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City | LOUISVILLE
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State | KY
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Zip | 40207-2005
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Country | US
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Telephone | 843-325-4165
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101282868
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License Number State | VA
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