Provider Demographics
NPI:1740418243
Name:GREENLEY, CHARLES TRAVIS (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:TRAVIS
Last Name:GREENLEY
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:7855 ARGYLE FOREST BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-5596
Mailing Address - Country:US
Mailing Address - Phone:904-282-6331
Mailing Address - Fax:904-282-4117
Practice Address - Street 1:11555 CENTRAL PKWY
Practice Address - Street 2:SUITE 304
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-2691
Practice Address - Country:US
Practice Address - Phone:904-265-7755
Practice Address - Fax:904-265-7754
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2015-07-13
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant