Provider Demographics
NPI:1508237116
Name:CASSIDY, CHARLES COLEMAN (PA-C)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:COLEMAN
Last Name:CASSIDY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 ANDY PEACH DR
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-3012
Mailing Address - Country:US
Mailing Address - Phone:615-218-5278
Mailing Address - Fax:
Practice Address - Street 1:2400 PATTERSON ST STE 100
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2385
Practice Address - Country:US
Practice Address - Phone:615-342-0038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-08
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2862363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN10397I6904Medicare PIN