Provider Demographics
NPI:1497770283
Name:JOELS, CHARLES SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:SCOTT
Last Name:JOELS
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 1:979 E 3RD ST STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2187
Mailing Address - Country:US
Mailing Address - Phone:423-267-0466
Mailing Address - Fax:423-757-0770
Practice Address - Street 1:2108 E 3RD ST
Practice Address - Street 2:SUITE 200
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-2600
Practice Address - Country:US
Practice Address - Phone:423-267-0466
Practice Address - Fax:423-757-0770
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43533208600000X
TNMD435332086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL621658774Medicaid
TN3001715Medicaid
GA828451186AMedicaid
TN4192330OtherBCBS
5194562OtherCIGNA
P00634995OtherRR MEDICARE
3001715Medicare PIN