MEDICARE: DR. CHARLES WAYNE PLUMMER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	24982	NC

General Provider Information

NPI Number	:	1285709691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES WAYNE PLUMMER M.D.

Provider Business Mailing Address
First Line	:	8606 YVONNE CT
Second Line	:
City	:	OAK RIDGE
State	:	NC
Zip	:	27310-0150
Country	:	US
Telephone Number	:	336-870-5084
Fax Number	:	336-441-8700

Provider Business Practice Location Address
First Line	:	530 N ELAM AVE
Second Line	:	SUITE C
City	:	GREENSBORO
State	:	NC
Zip	:	27403-1153
Country	:	US
Telephone Number	:	336-285-7853
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	07/21/2022

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