Provider Demographics
NPI:1154427680
Name:ALDRIDGE, CHARLES G
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:G
Last Name:ALDRIDGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1257 BRITTANY DR APT A
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-0249
Mailing Address - Country:US
Mailing Address - Phone:843-407-7334
Mailing Address - Fax:843-777-8705
Practice Address - Street 1:1257 BRITTANY DR APT A
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-0249
Practice Address - Country:US
Practice Address - Phone:843-407-7334
Practice Address - Fax:843-777-8705
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC186687367500000X
SCAPN3457367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN1643Medicaid