Provider Demographics
NPI:1780665745
Name:DEBUSK, CHARLES H (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:H
Last Name:DEBUSK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:309 N BROAD ST
Mailing Address - Street 2:P. O. BOX 1409
Mailing Address - City:NEW TAZEWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37825-6600
Mailing Address - Country:US
Mailing Address - Phone:423-626-7297
Mailing Address - Fax:423-626-5553
Practice Address - Street 1:309 N BROAD ST
Practice Address - Street 2:
Practice Address - City:NEW TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37825-6600
Practice Address - Country:US
Practice Address - Phone:423-626-7297
Practice Address - Fax:423-626-5553
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22172207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F23646Medicare UPIN