Provider Demographics
NPI:1649460213
Name:CHARLES R. ADCOCK, MDPC
Entity type:Organization
Organization Name:CHARLES R. ADCOCK, MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:BURROWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-837-7144
Mailing Address - Street 1:520 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH PITTSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37380-1633
Mailing Address - Country:US
Mailing Address - Phone:423-837-7144
Mailing Address - Fax:423-837-8428
Practice Address - Street 1:520 E 12TH ST
Practice Address - Street 2:
Practice Address - City:SOUTH PITTSBURG
Practice Address - State:TN
Practice Address - Zip Code:37380-1633
Practice Address - Country:US
Practice Address - Phone:423-837-7144
Practice Address - Fax:423-837-8428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD011688207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNC10664OtherMEDICARE RAILROAD
TN3723335Medicaid
TN3723335Medicaid
TNB03818Medicare UPIN