Provider Demographics
NPI:1215004643
Name:NIES, CHARLES M (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:M
Last Name:NIES
Suffix:
Gender:M
Credentials:PHD
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Mailing Address - Street 1:ONE NORTHGATE PARK
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415
Mailing Address - Country:US
Mailing Address - Phone:423-870-5647
Mailing Address - Fax:423-870-5545
Practice Address - Street 1:ONE NORTHGATE PARK
Practice Address - Street 2:SUITE 201
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37415
Practice Address - Country:US
Practice Address - Phone:423-870-5647
Practice Address - Fax:423-870-5545
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNP0000000887103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3092466OtherBC
TN3092466OtherBC