Individual
CHARLIE JOSEPH FAWCETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SON
Contact information
Practice address
4150 BOYSENBERRY LN, BURTON, MI 48529-2242
(810) 676-3220
Mailing address
11971 JUNIPER WAY APT 335, GRAND BLANC, MI 48439-2142
(810) 676-3222
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000000
VA
MI
Enumeration date
01/16/2023
Last updated
01/16/2023
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