Individual
MR. CHARLES DAVID DIETZEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4355 HIGHWAY 58, SUITE 101, CHATTANOOGA, TN 37416-2939
(423) 892-4289
(423) 892-8301
Mailing address
2621 CRESTWOOD DR, CHATTANOOGA, TN 37415-6321
(423) 266-3500
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
009627
TN
208D00000X
General Practice Physician
051638
GA
Other
Enumeration date
08/02/2006
Last updated
07/08/2007
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