Charles Aubrey Isham Jr., MD
Individual provider Active NPI Internal Medicine Physician · Jacksboro, TN
NPI 1184669269 · NPPES record last updated May 7, 2008
Key facts
- NPI
- 1184669269
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 13405 (TN)
- Practice address
- 163 Perkins LN
Jacksboro, TN 37757-2833 - Phone
- (423) 562-1181
- NPI assigned
- Jun 20, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040219000926 | TN | Practitioner - Internal Medicine | 9436044237 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13405 | TN | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Summit Medical Group, PLLC | Current |
Accepting new patients | |
| Summit Medical Group, PLLC | Internal Medicine | Current |
Accepting new patients |
Locations
163 Perkins Ln
Jacksboro, TN 37757
Phone (423) 500-9140
1225 E Weisgarber Rd
Ste 200
Knoxville, TN 37909
Phone (865) 938-3627
1275 Dick Lonas Rd
Unit 101
Knoxville, TN 37909
919 E Central Ave
Ste 202
La Follette, TN 37766
Phone (423) 566-8181
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 13405 | TN | Yes |
Addresses
Primary practice location
163 Perkins LN
Jacksboro, TN 37757-2833
Mailing address
1225 E Weisgarber Rd
Suite 200
Knoxville, TN 37909-2604
Phone (865) 584-4747
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110182715 | Other | TN | RR MEDICARE PIN |
| 3004504 | Medicaid | TN |
Other providers in Jacksboro, TN
- Andrew Wade Howard
- Elizabeth Thompson Howard
- Joshua Caine Huckaby
- Candace Linnea Hutson
- Independent Physical Therapy, LLC
- Jacksboro Urgent Care
- Daniel Howard Johnson
- Jessica Johnson
- Tammy R Jones
- Jeanette Marie Keith
All providers in Jacksboro, TN · Internal Medicine Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 7, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.