Provider Demographics
NPI:1639870124
Name:KING THARPE, CHARISSE M
Entity Type:Individual
Prefix:
First Name:CHARISSE
Middle Name:M
Last Name:KING THARPE
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 1:301 BARRINGTON HALL DR APT 215
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31220-0712
Mailing Address - Country:US
Mailing Address - Phone:478-279-9392
Mailing Address - Fax:
Practice Address - Street 1:301 BARRINGTON HALL DR APT 215
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31220-0712
Practice Address - Country:US
Practice Address - Phone:478-279-9392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA372500000X, 372600000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion