Provider Demographics
NPI:1992114433
Name:WOOSLEY, CHARLTON II
Entity type:Individual
Prefix:MR
First Name:CHARLTON
Middle Name:
Last Name:WOOSLEY
Suffix:II
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 1:2115 YEAMAN PL APT 308
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37206-4235
Mailing Address - Country:US
Mailing Address - Phone:615-477-9669
Mailing Address - Fax:
Practice Address - Street 1:2115 YEAMAN PL APT 308
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37206-4235
Practice Address - Country:US
Practice Address - Phone:615-477-9669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18975363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily