Provider Demographics
NPI:1124029194
Name:BRICE, CHARLES T (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:T
Last Name:BRICE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:979 E 3RD ST
Mailing Address - Street 2:STE 300
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2136
Mailing Address - Country:US
Mailing Address - Phone:423-267-0466
Mailing Address - Fax:423-757-0770
Practice Address - Street 1:979 E 3RD ST
Practice Address - Street 2:STE B 801
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2136
Practice Address - Country:US
Practice Address - Phone:423-267-2392
Practice Address - Fax:423-778-2433
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2016-07-11
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Provider Licenses
StateLicense IDTaxonomies
TNMD009287208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ022086OtherTENNCARE
B03325Medicare UPIN