Provider Demographics
NPI:1386495331
Name:PAULEY, CHARLES DAVID
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:DAVID
Last Name:PAULEY
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 1:426 UPPER RIVER RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25053-4564
Mailing Address - Country:US
Mailing Address - Phone:681-457-0443
Mailing Address - Fax:
Practice Address - Street 1:426 UPPER RIVER RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:WV
Practice Address - Zip Code:25053-4564
Practice Address - Country:US
Practice Address - Phone:681-457-0443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant