Provider Demographics
NPI:1780654285
Name:STIMPSON, CHARLES L (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:L
Last Name:STIMPSON
Suffix:
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 1:1701 N MAIN ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-2303
Mailing Address - Country:US
Mailing Address - Phone:931-685-4060
Mailing Address - Fax:931-685-4062
Practice Address - Street 1:1701 N MAIN ST
Practice Address - Street 2:SUITE D
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-2303
Practice Address - Country:US
Practice Address - Phone:931-685-4060
Practice Address - Fax:931-685-4062
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD15929207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3008490Medicaid
TN3008490Medicare PIN
TNA97304Medicare UPIN