Provider Demographics
NPI:1669866851
Name:SOUL HOSPITAL WITH DR. CHAR
Entity Type:Organization
Organization Name:SOUL HOSPITAL WITH DR. CHAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FRYE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, LPC-MHSP
Authorized Official - Phone:865-806-4403
Mailing Address - Street 1:1416 BREDA DR
Mailing Address - Street 2:PO BOX 5450
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-1401
Mailing Address - Country:US
Mailing Address - Phone:865-806-4403
Mailing Address - Fax:
Practice Address - Street 1:1416 BREDA DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-1401
Practice Address - Country:US
Practice Address - Phone:865-806-4403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3163251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002043100Medicaid