Provider Demographics
NPI:1497831242
Name:DINWIDDIE, CHARLES W (CRNA)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:W
Last Name:DINWIDDIE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 440352
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37244-0352
Mailing Address - Country:US
Mailing Address - Phone:615-620-2320
Mailing Address - Fax:615-620-2323
Practice Address - Street 1:2835 HIGHWAY 231 N
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-7327
Practice Address - Country:US
Practice Address - Phone:931-685-5433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN8781367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN01070162OtherAMERIGROUP TENNCARE ONLY
TN3634941Medicaid
TNP00136014OtherRR MEDICARE
TN4070725OtherBC/BS OF TN - NETWORKS P, S, BLUESELECT, BLUECARE
TN4070725OtherBC/BS OF TN - NETWORKS P, S, BLUESELECT, BLUECARE