NPIMap

Individual provider Active NPI

Charles Henry Phillips III, P.A.

  • Physician Assistant
  • North Wilkesboro, NC
National Provider Identifier
1760872808
Registry record updated Feb 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-05417 Issued in NC
Practice address
1915 W Park Dr Ste 103
North Wilkesboro, NC 28659-3777
Phone
(336) 838-9553
NPI assigned
Jan 28, 2015
Last updated
Feb 15, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0110005603 VA
Physician Assistant 363A00000X 0010-05417 NC Primary
Physician Assistant 363A00000X 41019 MT

Addresses

Primary practice location

1915 W Park Dr Ste 103
North Wilkesboro, NC 28659-3777

Mailing address

1915 W Park Dr Ste 103
North Wilkesboro, NC 28659-3777
Phone (336) 838-9553

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170410002261 NC Practitioner - Physician Assistant 5092023036 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1900 W Park Dr
Suite B
North Wilkesboro, NC 28659-3563
Phone (336) 903-6840

1914 W Park Dr
North Wilkesboro, NC 28659-3563
Phone (336) 903-7710

1916 W Park Dr
North Wilkesboro, NC 28659-3563
Phone (336) 838-9553

Medical Ctr Blvd
Winston Salem, NC 27157-0001
Phone (336) 716-2734

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
41019MTMDPhysician Assistant
0010-05417NCMDPhysician Assistant
0110005603VAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Forest University Health Sciences CurrentSince Jul 31, 2017 Accepting new patients
Wake Forest Health Network, LLC CurrentSince Oct 6, 2021 Accepting new patients
North Carolina Em-1 Medical Services, PC Physician Assistant CurrentSince Feb 9, 2017 Accepting new patients
Vidant Medical Group LLC CurrentSince Mar 13, 2017 Accepting new patients
Cornerstone Health Care, LLC CurrentSince Oct 6, 2021 Accepting new patients
Waterway Emergency Physicians LLC Past Accepting new patients
Frances Mahon Deaconess Hospital Past Accepting new patients

Locations

1144 N Road St
Elizabeth Cty, NC 27909
Phone (252) 384-4610

905 Phillips Ave
High Point, NC 27262
Phone (336) 802-2040

401 N Main St
Kenansville, NC 28349
Phone (910) 296-0941

1915 W Park Dr
Ste 103
North Wilkesboro, NC 28659
Phone (336) 838-9553

1916 W Park Dr
North Wilkesboro, NC 28659
Phone (336) 839-9563

100 Kimel Forest Dr
Winston Salem, NC 27103
Phone (336) 713-0947

Medical Ctr Blvd
Winston Salem, NC 27157
Phone (336) 713-2697

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1422403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771113600000",
    "number": "1760872808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1915 W PARK DR STE 103",
            "city": "NORTH WILKESBORO",
            "state": "NC",
            "postal_code": "286593777",
            "telephone_number": "336-838-9553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1915 W PARK DR STE 103",
            "city": "NORTH WILKESBORO",
            "state": "NC",
            "postal_code": "286593777",
            "telephone_number": "336-838-9553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "CHARLES",
        "middle_name": "HENRY",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-01-28",
        "last_updated": "2026-02-15",
        "certification_date": "2026-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110005603",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-05417",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MT",
            "license": "41019",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Wilkesboro, NC

Sources for this page

Verify at the official NPI Registry.