Provider Demographics
NPI:1831738178
Name:FRYAR-ROBINSON, CHARMAY DENEEN
Entity type:Individual
Prefix:MS
First Name:CHARMAY
Middle Name:DENEEN
Last Name:FRYAR-ROBINSON
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 1:3947 DUNN RD
Mailing Address - Street 2:
Mailing Address - City:EASTOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28312-8533
Mailing Address - Country:US
Mailing Address - Phone:910-483-6277
Mailing Address - Fax:910-483-6369
Practice Address - Street 1:3551 DUNN RD STE 101
Practice Address - Street 2:
Practice Address - City:EASTOVER
Practice Address - State:NC
Practice Address - Zip Code:28312-9417
Practice Address - Country:US
Practice Address - Phone:910-483-6277
Practice Address - Fax:910-483-6369
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-03
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFRYA-E02HVF363LA2200X
NC5012690363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5012690OtherSTATE LICENSE NUMBER