Individual
CHARLES AUBREY ISHAM JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
163 PERKINS LN, JACKSBORO, TN 37757-2833
(423) 562-1181
Mailing address
1225 E WEISGARBER RD, SUITE 200, KNOXVILLE, TN 37909-2604
(865) 584-4747
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
13405
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110182715
RR MEDICARE PIN
TN
05
—
3004504
—
TN
Enumeration date
06/20/2006
Last updated
05/07/2008
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