Provider Demographics
NPI:1609891803
Name:DRUMMOND, CHARLES S III (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:S
Last Name:DRUMMOND
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CHARLES
Other - Middle Name:S
Other - Last Name:DRUMMOND
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1958
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388
Mailing Address - Country:US
Mailing Address - Phone:931-841-3948
Mailing Address - Fax:931-841-3906
Practice Address - Street 1:315 NW ATLANTIC ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-3566
Practice Address - Country:US
Practice Address - Phone:931-841-3948
Practice Address - Fax:931-841-3906
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD394352086S0129X
TN39435208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4105344OtherBLUE CROSS BLUE SHEILD OF TENNESSEE
TN7468194OtherCIGNA
TNG14087Medicare UPIN
TN3328673Medicare Oscar/Certification