Provider Demographics
NPI:1710105754
Name:NICHOLSON, CHARLES PRESTON JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:PRESTON
Last Name:NICHOLSON
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 1:9000 AVIATION BLVD.
Mailing Address - Street 2:SUITE 116
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-0000
Mailing Address - Country:US
Mailing Address - Phone:704-795-2883
Mailing Address - Fax:
Practice Address - Street 1:9000 AVIATION BLVD.
Practice Address - Street 2:SUITE 116
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-0000
Practice Address - Country:US
Practice Address - Phone:704-795-2883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12004202C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner