Provider Demographics
NPI:1609840313
Name:ANDERSON, CHARLES B (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:B
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:410 N CEDAR BLUFF RD
Mailing Address - Street 2:STE 300
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-3632
Mailing Address - Country:US
Mailing Address - Phone:931-388-6404
Mailing Address - Fax:931-388-7119
Practice Address - Street 1:131 TUCKER STREET
Practice Address - Street 2:SUITE 5
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301
Practice Address - Country:US
Practice Address - Phone:931-388-6404
Practice Address - Fax:931-388-7119
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2016-05-18
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Provider Licenses
StateLicense IDTaxonomies
TNMD16686207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3026238Medicaid
TN3026239Medicare PIN
TN3026238Medicaid