Provider Demographics
NPI:1487139739
Name:MCELVEEN, CHARLES ANDREW (FNP-C)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:ANDREW
Last Name:MCELVEEN
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE
Mailing Address - State:GA
Mailing Address - Zip Code:31079-2046
Mailing Address - Country:US
Mailing Address - Phone:229-365-2570
Mailing Address - Fax:
Practice Address - Street 1:636 2ND AVE
Practice Address - Street 2:
Practice Address - City:ROCHELLE
Practice Address - State:GA
Practice Address - Zip Code:31079-2046
Practice Address - Country:US
Practice Address - Phone:229-365-2570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN247893363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily