Provider Demographics
NPI:1598806895
Name:FINCH, CHARLES DAVID JR (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:DAVID
Last Name:FINCH
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 1:1828 RAYMOND RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39204-4126
Mailing Address - Country:US
Mailing Address - Phone:601-331-2453
Mailing Address - Fax:601-372-3898
Practice Address - Street 1:1828 RAYMOND RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-4126
Practice Address - Country:US
Practice Address - Phone:601-331-2453
Practice Address - Fax:601-372-3898
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10768207P00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS10768OtherSTATE LICENSE
MS00017648Medicaid
MS00017648Medicaid
MS390000033Medicare PIN
MS302I112120Medicare PIN