Provider Demographics
NPI:1073594743
Name:CHARLES, CHRISTOPHER (MD, FAAP)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:
Last Name:CHARLES
Suffix:
Gender:M
Credentials:MD, FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 RAWLS DR
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-2852
Mailing Address - Country:US
Mailing Address - Phone:601-684-7623
Mailing Address - Fax:601-684-7247
Practice Address - Street 1:300 RAWLS DR
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-2852
Practice Address - Country:US
Practice Address - Phone:601-684-7623
Practice Address - Fax:601-684-7247
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18581208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1784940Medicaid
MS09730307Medicaid