1154943389 NPI number — CHARNELL C BROWN MAJOR ON MENTHAL HEA

Table of content: CHARNELL C BROWN MAJOR ON MENTHAL HEA (NPI 1154943389)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154943389 NPI number — CHARNELL C BROWN MAJOR ON MENTHAL HEA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
CHARNELL
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MAJOR ON MENTHAL HEA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BROWN
Provider Other First Name:
CHARNELL
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CHARNELL C BROWN
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1154943389
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 N MAIN ST STE 1202
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINSTON SALEM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27101-3819
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-721-4262
Provider Business Mailing Address Fax Number:
336-232-1630

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
127 TUNSTALL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24541-4236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-835-2983
Provider Business Practice Location Address Fax Number:
434-228-4786
Provider Enumeration Date:
05/11/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  0704010586 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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