Provider Demographics
NPI:1376003483
Name:BREWERTON, CHARLES HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:HENRY
Last Name:BREWERTON
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:2500 NORTH STATE STREET
Mailing Address - Street 2:DEPARTMENT OF OBSTETRICS & GYNECOLOGY/MFM DIVISION
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216
Mailing Address - Country:US
Mailing Address - Phone:601-815-9278
Mailing Address - Fax:601-984-6773
Practice Address - Street 1:2500 NORTH STATE STREET
Practice Address - Street 2:DEPARTMENT OF OBSTETRICS & GYNECOLOGY/MFM DIVISION
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216
Practice Address - Country:US
Practice Address - Phone:601-815-9278
Practice Address - Fax:601-984-6773
Is Sole Proprietor?:No
Enumeration Date:2019-03-24
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS31373207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology