Adcock, Charles Russell

Adcock, Charles Russell is an individual health care provider with primary practice located at 520 E 12Th St , South Pittsburg TN 37380-1633. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Adcock, Charles Russell can be contacted via phone (423) 837-7144.

Contact Information

Primary practice address
520 E 12Th St South Pittsburg TN 37380-1633
Phone: (423) 837-7144
Fax: (423) 837-8428
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X MD011688 Tennessee

Profile Details

NPI number 1669445532
LBN Legal business name Adcock, Charles Russell
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 9th, 2006
Last updated Jan 28th, 2009 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1669445532 NPPES
Tennessee MEDICAID 3723335
Tennessee Other 0010013492

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