Jackson, Charles Lee

Jackson, Charles Lee is an individual health care provider with primary practice located at 725 Glenwood Dr Ste E790, Chattanooga TN 37404-1178. He recently has only one registered license in Allopathic & Osteopathic Physicians / Urology, which is considered as his primary health care specialty. Jackson, Charles Lee can be contacted via phone (423) 495-3068.

Contact Information

Primary practice address
725 Glenwood Dr Ste E790 Chattanooga TN 37404-1178
Phone: (423) 495-3068
Fax: (423) 495-3022
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Urology 208800000X ME0053658 Florida
Allopathic & Osteopathic Physicians / Urology 208800000X 41776 Tennessee

Profile Details

NPI number 1942263793
LBN Legal business name Jackson, Charles Lee
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 11th, 2006
Last updated Jun 4th, 2010 - about 14 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 1942263793 NPPES
Florida MEDICAID 044337900
Florida MEDICAID 1507399

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