Provider Demographics
NPI:1720869621
Name:FIELDS, CHARLES (MDIV)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:FIELDS
Suffix:
Gender:M
Credentials:MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 FALL PIPPIN CT
Mailing Address - Street 2:
Mailing Address - City:CLARKESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30523-8407
Mailing Address - Country:US
Mailing Address - Phone:443-206-1496
Mailing Address - Fax:
Practice Address - Street 1:135 FALL PIPPIN CT
Practice Address - Street 2:
Practice Address - City:CLARKESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30523-8407
Practice Address - Country:US
Practice Address - Phone:443-206-1496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral