Provider Demographics
NPI:1003807355
Name:FAMOYIN, CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:FAMOYIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 WESLEY ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-1740
Mailing Address - Country:US
Mailing Address - Phone:423-282-0561
Mailing Address - Fax:423-268-2674
Practice Address - Street 1:302 WESLEY ST
Practice Address - Street 2:SUITE 3
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-1740
Practice Address - Country:US
Practice Address - Phone:423-282-0561
Practice Address - Fax:423-268-2674
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41664207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3833830Medicaid
TNH62051Medicare UPIN