Provider Demographics
NPI:1760405500
Name:LANNING, CHARLES B JR (MD)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:B
Last Name:LANNING
Suffix:JR
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 1:1421 W BADDOUR PKWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-2513
Mailing Address - Country:US
Mailing Address - Phone:615-449-6780
Mailing Address - Fax:615-449-1929
Practice Address - Street 1:1421 W BADDOUR PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-2513
Practice Address - Country:US
Practice Address - Phone:615-449-6780
Practice Address - Fax:615-449-1929
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD14170174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3006878Medicaid
TN3006871Medicare ID - Type Unspecified
TN3006878Medicaid