Provider Demographics
NPI:1962512582
Name:NORRIS, CHARLIE DEMETRIUS
Entity type:Individual
Prefix:MR
First Name:CHARLIE
Middle Name:DEMETRIUS
Last Name:NORRIS
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 1:5888 RONNIE DR
Mailing Address - Street 2:
Mailing Address - City:REX
Mailing Address - State:GA
Mailing Address - Zip Code:30273-1060
Mailing Address - Country:US
Mailing Address - Phone:937-241-3162
Mailing Address - Fax:
Practice Address - Street 1:ATLANTA VETERANS ADMINISTRATION MEDICAL CENTER
Practice Address - Street 2:1670 CLAIRMONT ROAD
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033
Practice Address - Country:US
Practice Address - Phone:404-321-6111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)