1275506594 NPI number — DR. CHARLES WHITLEY EMERSON JR. MD

Table of content: DR. CHARLES WHITLEY EMERSON JR. MD (NPI 1275506594)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275506594 NPI number — DR. CHARLES WHITLEY EMERSON JR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EMERSON
Provider First Name:
CHARLES
Provider Middle Name:
WHITLEY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275506594
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1321 MURFREESBORO RD
Provider Second Line Business Mailing Address:
STE 510
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-366-8890
Provider Business Mailing Address Fax Number:
615-366-3379

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
394 HARDING PLACE
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-834-4482
Provider Business Practice Location Address Fax Number:
615-834-4722
Provider Enumeration Date:
02/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  3793 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3080212 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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