MEDICARE: MR. CHARLES HART M.S., ATC

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	2255A2300X	Athletic Trainer	1177	SC

General Provider Information

NPI Number	:	1962811315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES HART M.S., ATC

Provider Business Mailing Address
First Line	:	11012 HUNTER TRAIL LN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-1625
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1162 EDEN TER
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29730-3208
Country	:	US
Telephone Number	:	803-242-3242
Fax Number	:

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

Provider Enumeration Date	:	08/11/2014
Last Update Date	:	08/11/2014

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