Provider Demographics
NPI:1518401306
Name:MCCOY, CHARIESE
Entity Type:Individual
Prefix:
First Name:CHARIESE
Middle Name:
Last Name:MCCOY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 ABERCORN ST 108-A
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406
Mailing Address - Country:US
Mailing Address - Phone:912-844-1344
Mailing Address - Fax:912-303-8649
Practice Address - Street 1:8400 ABERCORN ST
Practice Address - Street 2:108-A
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3425
Practice Address - Country:US
Practice Address - Phone:912-335-2636
Practice Address - Fax:912-330-1189
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-13
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025-R-1712376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide