Provider Demographics
NPI:1720069933
Name:BURGER, CHARLES WILLIAM (MD)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:WILLIAM
Last Name:BURGER
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:PO BOX 577
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-0577
Mailing Address - Country:US
Mailing Address - Phone:931-363-2511
Mailing Address - Fax:931-424-6109
Practice Address - Street 1:215 S CEDAR LN
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-3502
Practice Address - Country:US
Practice Address - Phone:931-363-2511
Practice Address - Fax:931-424-6109
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9613207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3167818Medicaid
3167817Medicare ID - Type Unspecified
TN3167818Medicaid