Individual
DR. CHARLES T. BEAVERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6019 WALNUT GROVE RD, MEMPHIS, TN 38120-2113
(901) 227-5135
Mailing address
5301 VIRGINIA WAY STE 300, BRENTWOOD, TN 37027-7542
(615) 221-4400
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
04-45362
KS
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
2014007653
MO
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
73079
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04-45362
LICENSE
KS
Enumeration date
04/01/2009
Last updated
12/13/2024
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