Active NPI
Charles D Harris, M.D.
- Family Medicine Physician
- Hixson, TN
National Provider Identifier
1972636983
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD0000011415
- Practice address
- 5000 Alpha LN
Hixson, TN 37343-4054 - Phone
- (423) 870-1662
- Fax
- (423) 877-4845
- NPI assigned
- Mar 13, 2007
- Last updated
- Dec 18, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD0000011415 | TN | Primary |
Addresses
Primary practice location
5000 Alpha LN
Hixson, TN 37343-4054
Mailing address
PO Box 22696
Chattanooga, TN 37422-2696
Phone (423) 870-1662
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3168293 | Medicaid | TN | |
| 080163948 | Other | TN | MEDICARE RR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD0000011415 | TN | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Healthforce of Dayton, Inc | Family Medicine | Current | Accepting new patients |
| Erlanger Health | Past | Accepting new patients |
Locations
260 16th Ave
Unit 120
Dayton, TN 37321
Phone (423) 499-5655
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.
-
- Durable Medical Equipment & Medical Supplies
- Chattanooga, TN
- NPI 1740073329
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173744000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1355788800000",
"number": "1972636983",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 22696",
"city": "CHATTANOOGA",
"state": "TN",
"postal_code": "374222696",
"telephone_number": "423-870-1662",
"fax_number": "423-877-4845"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5000 ALPHA LN",
"city": "HIXSON",
"state": "TN",
"postal_code": "373434054",
"telephone_number": "423-870-1662",
"fax_number": "423-877-4845"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARRIS",
"first_name": "CHARLES",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-13",
"last_updated": "2012-12-18",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "TN",
"license": "MD0000011415",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3168293",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RR",
"identifier": "080163948",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hixson, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.