Individual
MR. CHARLES MANSON WYATT
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
M-48611 LOGISTICS AVE, JOEL HEALTH CLINIC, FORT BRAGG, NC 28310-0001
(910) 907-9166
Mailing address
2539 CAMERON WOODS LN, FAYETTEVILLE, NC 28306-7782
(910) 907-9116
(910) 907-9828
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
100493
NC
Other
Enumeration date
03/14/2006
Last updated
07/08/2007
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