Provider Demographics
NPI:1922267368
Name:KATES, CHARITY
Entity type:Individual
Prefix:
First Name:CHARITY
Middle Name:
Last Name:KATES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 FAIRVIEW RD STE 325
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9514
Mailing Address - Country:US
Mailing Address - Phone:704-444-0999
Mailing Address - Fax:
Practice Address - Street 1:150 FAIRVIEW RD STE 325
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9514
Practice Address - Country:US
Practice Address - Phone:704-444-0999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2011-01806207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1922267368Medicaid
NC5919153Medicaid
NCNC4047AMedicare PIN