Charles Samuel Fussell Sr., D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS002432 Issued in TN

Practice address

4610 Brainerd Rd
Chattanooga, TN 37411-3835

Phone

(423) 698-8619

Fax

(423) 698-8610

NPI assigned

Oct 21, 2006

Last updated

Jul 8, 2007By 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1161388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1144303512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4610 BRAINERD RD",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374113835",
            "telephone_number": "423-698-8619",
            "fax_number": "423-698-8610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4610 BRAINERD RD",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374113835",
            "telephone_number": "423-698-8619",
            "fax_number": "423-698-8610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUSSELL",
        "first_name": "CHARLES",
        "middle_name": "SAMUEL",
        "name_prefix": "Dr.",
        "name_suffix": "Sr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "DS002432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grace Ann Fulton, APN
• Randall L Funderburk, MD
• Erin Melsa Furnish, LPC-MHSP
• Joe Furr, M.D.
• Fusion Fitness & Physical Therapy Center, LLC
• G. Gary Leigh, PH.D., P.C.
• Stephanie Elaine Gabor, RDH
• Maxwell Gabrielly
• Holly Gadd, NP
• Heather Michelle Gager, MSN, APRN, FNP-C

• General Practice Dentistry in Chattanooga, TN
• Providers in Chattanooga, TN by specialty
• General Practice Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.