Individual
CHARLES MATTHEW STREET
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
170 W TENNESSEE AVE, OAK RIDGE, TN 37830-6509
(865) 482-1788
(865) 482-1789
Mailing address
170 W TENNESSEE AVE, OAK RIDGE, TN 37830-6509
(865) 482-1788
(865) 482-1789
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
09/16/2019
Last updated
09/16/2019
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