Charles B Anderson, M.D.
Individual provider Active NPI Anesthesiology Physician · Jackson, TN
NPI 1609840313 · NPPES record last updated May 18, 2016
Key facts
- NPI
- 1609840313
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Anesthesiology Physician 207L00000X
- License
- MD16686 (TN)
- Practice address
- 131 Tucker Street
Suite 5
Jackson, TN 38301 - Phone
- (931) 388-6404
- Fax
- (931) 388-7119
- NPI assigned
- Feb 17, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD16686 | TN | MD | Anesthesiology Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | MD16686 | TN | Yes |
Addresses
Primary practice location
131 Tucker Street
Suite 5
Jackson, TN 38301
Mailing address
410 N Cedar Bluff Rd
Ste 300
Knoxville, TN 37923-3632
Phone (931) 388-6404
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3026238 | Medicaid | TN |
Other providers in Jackson, TN
- Anchors in Bloom Counseling LLC
- Anderson Brace & Limb PLLC
- Alexandra Laine Anderson
- Anahita Anderson
- Brittany Zinelle Anderson
- Cynthia G Anderson
- Edward J Anderson
- Jonathan O Anderson
- Keith Anderson Jr.
- Mary Elisabeth Neal Anderson
All providers in Jackson, TN · Anesthesiology 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 18, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.