Charles Russell Adcock, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD011688 Issued in TN

Practice address

520 E 12TH St
South Pittsburg, TN 37380-1633

Phone

(423) 837-7144

Fax

(423) 837-8428

NPI assigned

Feb 9, 2006

Last updated

Jan 28, 2009By 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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1139443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1233100800000",
    "number": "1669445532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 E 12TH ST",
            "city": "SOUTH PITTSBURG",
            "state": "TN",
            "postal_code": "373801633",
            "telephone_number": "423-837-7144",
            "fax_number": "423-837-8428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 E 12TH ST",
            "city": "SOUTH PITTSBURG",
            "state": "TN",
            "postal_code": "373801633",
            "telephone_number": "423-837-7144",
            "fax_number": "423-837-8428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADCOCK",
        "first_name": "CHARLES",
        "middle_name": "RUSSELL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-09",
        "last_updated": "2009-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "MD011688",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3723335",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "0010013492",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in South Pittsburg, TN
• Providers in South Pittsburg, TN by specialty
• Family Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.