Provider Demographics
NPI:1114217288
Name:PICKENS, CHARLIE JR (MD)
Entity Type:Individual
Prefix:
First Name:CHARLIE
Middle Name:
Last Name:PICKENS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1091 KIRKPATRICK RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-9714
Mailing Address - Country:US
Mailing Address - Phone:336-538-1880
Mailing Address - Fax:336-538-1895
Practice Address - Street 1:2301 ERWIN RD
Practice Address - Street 2:DUKE UNIVERSITY HOSPITAL
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4699
Practice Address - Country:US
Practice Address - Phone:919-668-2591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2015-01044207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology