Provider Demographics
NPI:1477969368
Name:FISHER, CHARLES RUSSELL III
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:RUSSELL
Last Name:FISHER
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 HARTSVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37030-2100
Mailing Address - Country:US
Mailing Address - Phone:615-281-8093
Mailing Address - Fax:
Practice Address - Street 1:266 HARTSVILLE PIKE
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:TN
Practice Address - Zip Code:37030-2100
Practice Address - Country:US
Practice Address - Phone:615-281-8093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator