Individual provider Active NPI

Charles Tyler Thacker, DO

  • Emergency Medicine Physician
  • Dalton, GA
National Provider Identifier
1902501778
Registry record updated Sep 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
6328 Issued in TN
Practice address
1200 Memorial Dr
Dalton, GA 30720-2529
Phone
(706) 272-6000
NPI assigned
Apr 3, 2023
Last updated
Sep 3, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 109471 GA
Student in an Organized Health Care Education/Training Program 390200000X
Emergency Medicine Physician 207P00000X 6328 TN Primary

Addresses

Primary practice location

1200 Memorial Dr
Dalton, GA 30720-2529

Mailing address

1200 Memorial Dr
Dalton, GA 30720-2529
Phone (706) 272-6000

Other practice location 1

16931 Rankin Ave # 100
Dunlap, TN 37327-7029
Phone (423) 949-2000

Other practice location 2

975 E 3rd St
Chattanooga, TN 37403-2173
Phone (423) 778-7628

Medicare participation

Medicare enrollment files
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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250912000241 TN Practitioner - Emergency Medicine 6507223781 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tennessee River Physicians, PLLCGroup PAC ID 8022387349, 65 clinicians

Practice addresses (Care Compare)

975 E 3Rd St
Chattanooga, TN 37403-2173
Phone (423) 778-7000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Tennessee River Physicians, PLLC Emergency Medicine CurrentSince Aug 1, 2025 Accepting new patients
Tennessee River Physicians, PLLC Emergency Medicine CurrentSince Aug 1, 2025 Accepting new patients

Locations

5665 New Northside Dr
Ste 320
Sandy Springs, GA 30328
Phone (770) 874-5468

1751 Gunbarrel Rd
Chattanooga, TN 37421
Phone (423) 680-8000

975 E 3rd St
Chattanooga, TN 37403
Phone (423) 266-1499

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1680480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788393600000",
    "number": "1902501778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 MEMORIAL DR",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "307202529",
            "telephone_number": "706-272-6000",
            "fax_number": "706-272-6111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 MEMORIAL DR",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "307202529",
            "telephone_number": "706-272-6000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16931 Rankin Ave # 100",
            "address_purpose": "LOCATION",
            "city": "Dunlap",
            "state": "TN",
            "postal_code": "373277029",
            "country_code": "US",
            "telephone_number": "423-949-2000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "975 E 3rd St",
            "address_purpose": "LOCATION",
            "city": "Chattanooga",
            "state": "TN",
            "postal_code": "374032173",
            "country_code": "US",
            "telephone_number": "423-778-7628",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THACKER",
        "first_name": "CHARLES",
        "middle_name": "TYLER",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-04-03",
        "last_updated": "2026-09-03",
        "certification_date": "2026-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "GA",
            "license": "109471",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TN",
            "license": "6328",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dalton, GA

Sources for this page

Verify at the official NPI Registry.