Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 1337 | SC |
NPI | 1023182441 |
---|---|
Provider Name | Charles H. Weston JR. |
First Address | Greenwood, SC 29649-1439 |
Second Address | Greenwood, SC 29649-1439 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2006 |
Last Update Date | 30/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CS1337 | (05) | SC |
T86080 | (02) | SC |