Provider Demographics
NPI:1295744043
Name:HUDDLESTON, CHARLES LOUIS (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:LOUIS
Last Name:HUDDLESTON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1041 BELOTES FERRY RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-7910
Mailing Address - Country:US
Mailing Address - Phone:615-449-8675
Mailing Address - Fax:
Practice Address - Street 1:3400 LEBANON RD
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-1237
Practice Address - Country:US
Practice Address - Phone:615-867-6117
Practice Address - Fax:615-867-5781
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN21416208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNE71157Medicare UPIN