Individual
CHARLES E FREDERICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2000 CHURCH ST, NASHVILLE, TN 37236-0001
(800) 251-2014
(615) 284-3854
Mailing address
1 VANTAGE WAY, SUITE B240, NASHVILLE, TN 37228-1515
(615) 329-4020
(615) 327-4403
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
28703
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3062222
BLUECROSS
TN
01
—
3110235
STONES RIVER IPA
TN
05
—
3816000
—
TN
01
—
64028434
KY MEDICAID
KY
Enumeration date
06/18/2006
Last updated
06/10/2010
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