MEDICARE: DR. CHARLES GRAYSON GUYER EDD

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	103T00000X	Psychologist	0694	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982680328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES GRAYSON GUYER EDD

Provider Business Mailing Address
First Line	:	217 STATION STREET
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546
Country	:	US
Telephone Number	:	910-353-1461
Fax Number	:	910-353-1461

Provider Business Practice Location Address
First Line	:	217 STATION ST
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-6304
Country	:	US
Telephone Number	:	910-353-1461
Fax Number	:	910-353-1461

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

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	06/27/2008

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