Provider Demographics
NPI:1982684361
Name:COX, CHARLES BOGGESS (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:BOGGESS
Last Name:COX
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 1:503 W MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303-3489
Mailing Address - Country:US
Mailing Address - Phone:423-745-2312
Mailing Address - Fax:423-746-0687
Practice Address - Street 1:503 W MADISON AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-3489
Practice Address - Country:US
Practice Address - Phone:423-745-2312
Practice Address - Fax:423-746-0687
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18827208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ031940Medicaid
TN3033811Medicaid
TN3384691Medicaid
TN79908OtherBCBS-TN
TN79908OtherBCBS-TN
TNB59045Medicare UPIN