TIMOTHY DOUGLAS (NPI# 1841603529) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1841603529 |
| Entity Type | Individual |
| Full Name | TIMOTHY DOUGLAS |
| Credential | PA-C |
| Practice Address |
4202 Mccorkle Ave Sw Ste 200 South Charleston WV 25309-1513 |
| Practice Telephone | 3049257546 |
| Practice Fax Number | 6812058369 |
| Mailing Telephone | 3049257546 |
| Mailing Fax Number | 6812058369 |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2020-09-30 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669760732 | Timothy Lee Douglas | Counselor | 2754 Compass Dr Ste 377, Grand Junction, CO 81506-8723 | 2011-07-11 |
| 1982852349 | Timothy Douglas | Physical Therapy Assistant | 101 Villa Dr, Daphne, AL 36526-4653 | 2008-08-28 |
| Street Address |
4202 MCCORKLE AVE SW STE 200 |
| City | SOUTH CHARLESTON |
| State | WV |
| Zip Code | 25309-1513 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699376905 | Lovie Bradshaw | Technician | 4823 Tennessee St., South Charleston, WV 25309 | 2020-11-03 |
| 1306447735 | Barbara Mackenzie | Technician | 4224 Kanawha Turnpike, South Charleston, WV 25309 | 2020-11-03 |
| 1548861974 | Sarah Nichols | Technician | 4990 Colonial Park Dr. Apt. F, South Charleston, WV 25309 | 2020-11-03 |
| 1629690177 | Jennifer Mabry-goins | Technician | 4505 River Avenue, S Charleston, WV 25309 | 2020-05-07 |
| 1811537715 | Brandon C Dean | Psychologist | 4857 Macorkle Ave. Sw, South Charleston, WV 25309 | 2020-01-09 |
| 1467096057 | Linda Mullins | Technician | 60 Hayvon Lane, South Charleston, WV 25309 | 2019-11-06 |
| 1831743616 | Ann Myriah Beck | Nurse Practitioner | 4610 Maccorkle Ave Sw # 300, South Charleston, WV 25309 | 2019-07-30 |
| 1942671227 | Edward W Eskew | Family Medicine | 4605 Maccorkle Avenue, Sw, Thspp-psychiatry, South Charleston, WV 25309 | 2015-10-13 |
| 1720468218 | Link Investments LLC | Pharmacy | 5151 Macorkle Avenue, South Charleston, WV 25309 | 2015-06-01 |
| 1366840951 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 304 Southbridge Blvd., S.ccharleston, WV 25309 | 2014-12-12 |
| Find all providers in zip 25309 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407006323 | Connie Fay Dorfner | Physician Assistant | 18 River Walk Mall, South Charleston, WV 25303-1026 | 2008-09-28 |
| 1972609550 | Anthony B Knell | Physician Assistant | 500 Poplar St Ste 301, South Charleston, WV 25309-1473 | 2006-09-15 |
| 1639100266 | Kristine K Agnew | Physician Assistant | 4607 Maccorkle Ave Sw Ste 206, South Charleston, WV 25309-1364 | 2006-07-05 |
| 1407850332 | Brandy Huss Boyd | Physician Assistant | 215 Southern Woods Dr, South Charleston, WV 25309-8692 | 2005-06-09 |
| 1215491105 | Kelsey Dawn Mathis | Physician Assistant | 401 Division St Ste 306, South Charleston, WV 25309-1455 | 2019-01-25 |
| 1477047314 | Holli Lucia Dalton | Physician Assistant | 4610 Kanawha Ave Sw Ste 200, South Charleston, WV 25309-1367 | 2018-06-14 |
| 1821519398 | Erika B. Saunders | Physician Assistant | 4610 Kanawha Ave Sw Ste 402, South Charleston, WV 25309 | 2017-07-05 |
| 1184014128 | Alice Stanley | Physician Assistant | 4605 Maccorkle Ave Sw, South Charleston, WV 25309-1311 | 2015-01-29 |
| 1295170587 | Katherine Elizabeth Boggs | Physician Assistant | 4619 Kanawha Avenue Sw, South Charleston, WV 25309 | 2013-05-01 |
| 1801230842 | Melisa Jane Snodgrass | Physician Assistant | 4605 Maccorkle Ave Sw, South Charleston, WV 25309-1311 | 2013-04-22 |
| Find all providers in SOUTH CHARLESTON | ||||
| City | SOUTH CHARLESTON |
| Zip Code | 25309 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.