Charles Andrew Nicholas III, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS004224 Issued in TN

Practice address

40 25TH St NW
Cleveland, TN 37311-3829

Phone

(423) 476-4418

Fax

(423) 476-0189

NPI assigned

Dec 12, 2006

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

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1982765202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 25TH ST NW",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "373113829",
            "telephone_number": "423-476-4418",
            "fax_number": "423-476-0189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 25TH ST NW",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "373113829",
            "telephone_number": "423-476-4418",
            "fax_number": "423-476-0189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLAS",
        "first_name": "CHARLES",
        "middle_name": "ANDREW",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "DS004224",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Neighbor Links LLC
• New Life Choices, PLLC
• J Wayne Newman, DDS, MS
• Jerry Glynn Newman Jr., MD
• Whitney Nicole Newman, BEHAVIOR TECHNICIAN
• Janice Breaux Nicholas, D.D.S.
• Briana Nicole Nicholson, NP
• Vanessa Jean Nicholson
• Emily Nicodemus
• Cynthia M. Niendorff, MD

• General Practice Dentistry in Cleveland, TN
• Providers in Cleveland, TN by specialty
• General Practice Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.