Charles Anthony Ancrum, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

622351 Issued in NY

Practice address

20 Riverstone Dr
Covington, GA 30014-5027

Phone

(404) 510-5027

NPI assigned

Aug 10, 2009

Last updated

Sep 6, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1249862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757116800000",
    "number": "1306078357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 RIVERSTONE DR",
            "city": "COVINGTON",
            "state": "GA",
            "postal_code": "300145027",
            "telephone_number": "404-510-5027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 RIVERSTONE DR",
            "city": "COVINGTON",
            "state": "GA",
            "postal_code": "300145027",
            "telephone_number": "404-510-5027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANCRUM",
        "first_name": "CHARLES",
        "middle_name": "ANTHONY",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-08-10",
        "last_updated": "2025-09-06",
        "certification_date": "2025-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "622351",
            "primary": true
        },
        {
            "code": "163WA2000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Administrator",
            "state": "GA",
            "license": "622351-01",
            "primary": false
        },
        {
            "code": "163WC0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Critical Care Medicine",
            "state": "GA",
            "license": "622351-01",
            "primary": false
        },
        {
            "code": "163WC1600X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Continuing Education/Staff Development",
            "state": "GA",
            "license": "622351-01",
            "primary": false
        },
        {
            "code": "163WW0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Wound Care",
            "state": "GA",
            "license": "622351-01",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Michael Anderson, LPC
• Monica Anderson, CA

• Registered Nurse in Covington, GA
• Providers in Covington, GA by specialty
• Registered Nurse in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.