Provider Demographics
NPI:1588152425
Name:RALPH, CHARLES JAMES (MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:JAMES
Last Name:RALPH
Suffix:
Gender:M
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8417 W ASKERSUND CV
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-6837
Mailing Address - Country:US
Mailing Address - Phone:903-969-0545
Mailing Address - Fax:
Practice Address - Street 1:1450 HIGHWAY 6 E
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-9213
Practice Address - Country:US
Practice Address - Phone:662-563-4116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSAT08972255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer