Charles David Anderson, PA-C
Individual provider Active NPI Physician Assistant · Johnson City, TN
NPI 1992775282 · NPPES record last updated Mar 26, 2008
Key facts
- NPI
- 1992775282
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 147 (TN)
- Practice address
- 3 Professional Park Dr
Suite 21
Johnson City, TN 37604-6529 - Phone
- (423) 434-6300
- Fax
- (423) 434-6312
- NPI assigned
- Jan 26, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Appalachian Orthopaedic Associates, PC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 147 | TN | Yes |
Addresses
Primary practice location
3 Professional Park Dr
Suite 21
Johnson City, TN 37604-6529
Mailing address
3 Professional Park Dr
Suite 21
Johnson City, TN 37604-6529
Phone (423) 434-6300
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3665019 | Medicaid | TN |
Other providers in Johnson City, TN
- Rachel Jarratt Amodei
- Rajani Anand
- Sheeba Anand
- Luke Noble Anders
- Michael H Anders
- Emma Anderson
- Madison Anderson
- Noah Anderson
- Noah Scott Anderson
- Rachel Anne Anderson
All providers in Johnson City, TN · Physician Assistant in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 26, 2008. 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.