Provider Demographics
NPI:1750024451
Name:PRESCOTT, CHARLIE JR (RN, BSN)
Entity Type:Individual
Prefix:
First Name:CHARLIE
Middle Name:
Last Name:PRESCOTT
Suffix:JR
Gender:M
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 MONROE CT
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-9243
Mailing Address - Country:US
Mailing Address - Phone:706-910-7391
Mailing Address - Fax:
Practice Address - Street 1:3511 MONROE CT
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-9243
Practice Address - Country:US
Practice Address - Phone:706-910-7391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN219326163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse