Provider Demographics
NPI:1700884558
Name:MAUNEY, CHARLES JEFFERSON (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JEFFERSON
Last Name:MAUNEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:CHARLES
Other - Middle Name:
Other - Last Name:MAUNEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:707 N MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-3840
Mailing Address - Country:US
Mailing Address - Phone:704-487-6672
Mailing Address - Fax:704-487-7863
Practice Address - Street 1:707 N MORGAN ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3840
Practice Address - Country:US
Practice Address - Phone:704-487-6672
Practice Address - Fax:704-487-7863
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCMA-8908117Medicaid
NCT64019Medicare UPIN
NCMA-8908117Medicaid