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General NPI Number Information
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NPI Number | 1891886636
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Entity Type | Organization
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Legal Business Name | CHARLESTON FAMILY HEALTH ASSOC
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1218 VIRGINIA STREET EAST SUITE A
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City | CHARLESTON
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State | WV
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Zip | 25301
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Country | US
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Telephone | 304-345-8500
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Fax | 304-345-8979
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Provider Business Mailing Address
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Address Line | 1218 VIRGINIA STREET EAST SUITE A
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City | CHARLESTON
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State | WV
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Zip | 25301
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Country | US
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Telephone | 304-345-8500
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Fax | 304-345-8979
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. DEBRA LYNN FR
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Credential |
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Telephone | 304-345-8500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 17020
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 17129
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License Number State | WV
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