Active NPI
Charles E Andereson MD PC
- General Practice Physician
- Tullahoma, TN
National Provider Identifier
1174576920
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- MD14122
- Legal business name
- CHARLES E ANDERESON MD PC
- Doing business as
- Tullahoma Laser Center
- Practice address
- 2336 N Jackson St
Tullahoma, TN 37388 - Phone
- (931) 393-0600
- Fax
- (931) 393-0656
- NPI assigned
- May 19, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Charles E Anderson, MD
- Title
- President
- Phone
- (931) 393-0600
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | MD14122 | TN | Primary |
Addresses
Primary practice location
2336 N Jackson St
Tullahoma, TN 37388
Mailing address
2336 N Jackson St
PO Box 1840
Tullahoma, TN 37388
Phone (931) 393-0600
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3197128 | Medicaid | TN | |
| 4009762 | Other | TN | BCBS OF TN |
| 7240951 | Other | TN | CIGNA HEALTH CARE |
Other names 1
- Tullahoma Laser Center
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147996800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1174576920",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2336 N JACKSON ST",
"address_2": "PO BOX 1840",
"city": "TULLAHOMA",
"state": "TN",
"postal_code": "37388",
"telephone_number": "931-393-0600",
"fax_number": "931-393-0656"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2336 N JACKSON ST",
"city": "TULLAHOMA",
"state": "TN",
"postal_code": "37388",
"telephone_number": "931-393-0600",
"fax_number": "931-393-0656"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CHARLES E ANDERESON MD PC",
"organizational_subpart": "NO",
"enumeration_date": "2006-05-19",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "ANDERSON",
"authorized_official_first_name": "CHARLES",
"authorized_official_middle_name": "E",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "931-393-0600",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "General Practice",
"state": "TN",
"license": "MD14122",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3197128",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF TN",
"identifier": "4009762",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA HEALTH CARE",
"identifier": "7240951",
"state": "TN"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Tullahoma Laser Center",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Tullahoma, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.