Provider Demographics
NPI:1639708035
Name:HAVILL, CHARITY (PA-C)
Entity Type:Individual
Prefix:
First Name:CHARITY
Middle Name:
Last Name:HAVILL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 CLIFTY DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-1627
Mailing Address - Country:US
Mailing Address - Phone:812-265-6800
Mailing Address - Fax:
Practice Address - Street 1:1801 CLIFTY DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-1627
Practice Address - Country:US
Practice Address - Phone:812-265-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant