Basic Information
| Provider Information | |||||||||
| NPI: | 1053378604 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROOKS | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 102 HANDLEY PARK CT | ||||||||
| Address2: | |||||||||
| City: | GOLDSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275341768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197343344 | ||||||||
| FaxNumber: | 9197353025 | ||||||||
| Practice Location | |||||||||
| Address1: | 102 HANDLEY PARK COURT | ||||||||
| Address2: | |||||||||
| City: | GOLDSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197343344 | ||||||||
| FaxNumber: | 9197353025 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2006 | ||||||||
| LastUpdateDate: | 04/03/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 28622 | NC | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 8918571 | 05 | NC | MEDICAID |