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NPI Code Detail

MEDICARE: MR. CHARLES CLAYBORN PULLIAM II PA-C

MEDICARE: MR. CHARLES CLAYBORN PULLIAM II PA-C
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
1363AM0700XMedical Physician Assistant103393NC

General Provider Information

NPI Number : 1710060462
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CHARLES CLAYBORN PULLIAM II PA-C
Provider Business Mailing Address
First Line : 475 PROGRESS BLVD
Second Line :
City : SILER CITY
State : NC
Zip : 27344-6787
Country : US
Telephone Number : 919-799-4000
Fax Number : 919-799-4011
Provider Business Practice Location Address
First Line : 475 PROGRESS BLVD
Second Line :
City : SILER CITY
State : NC
Zip : 27344-6787
Country : US
Telephone Number : 919-799-4000
Fax Number : 919-799-4011
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2006
Last Update Date : 04/01/2021

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