Individual
CHARLES ALEXANDER KIDD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
207 ELK AVE S, FAYETTEVILLE, TN 37334-3051
(931) 433-2551
(931) 438-0069
Mailing address
1 INDEPENDENCE PT STE 212, RESIDENT ENROLLMENT, GREENVILLE, SC 29615-4536
(864) 455-7844
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
38504
SC
207R00000X
Internal Medicine Physician
Primary
56894
TN
208000000X
Pediatrics Physician
38504
SC
Other
Enumeration date
06/17/2015
Last updated
06/13/2019
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