Provider Demographics
NPI:1609031400
Name:WOFFORD, CHARLIE JEAN (MD)
Entity Type:Individual
Prefix:
First Name:CHARLIE
Middle Name:JEAN
Last Name:WOFFORD
Suffix:
Gender:F
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:PO BOX 3788
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29230-3788
Mailing Address - Country:US
Mailing Address - Phone:803-733-5969
Mailing Address - Fax:803-217-0026
Practice Address - Street 1:1136 KINCAID BRIDGE RD
Practice Address - Street 2:SUITE A
Practice Address - City:WINNSBORO
Practice Address - State:SC
Practice Address - Zip Code:29180-7116
Practice Address - Country:US
Practice Address - Phone:803-635-1052
Practice Address - Fax:803-712-9724
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC32464207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC324644Medicaid