Provider Demographics
NPI:1831546019
Name:MORRIS, CHARLETTE
Entity type:Individual
Prefix:
First Name:CHARLETTE
Middle Name:
Last Name:MORRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 HAMPTON HALL RD
Mailing Address - Street 2:
Mailing Address - City:CALLAO
Mailing Address - State:VA
Mailing Address - Zip Code:22435-2618
Mailing Address - Country:US
Mailing Address - Phone:804-296-6930
Mailing Address - Fax:804-529-1034
Practice Address - Street 1:1836 HAMPTON HALL RD
Practice Address - Street 2:
Practice Address - City:CALLAO
Practice Address - State:VA
Practice Address - Zip Code:22435-2618
Practice Address - Country:US
Practice Address - Phone:804-296-6930
Practice Address - Fax:804-529-1034
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA47-3353770344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi