Individual
MR. CHARLES BOLICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
240 MEDICAL PARK BLVD, STE 3000, BRISTOL, TN 37620-7352
(423) 990-2400
Mailing address
PO BOX 9, KINGSPORT, TN 37662-0009
(423) 857-2066
(423) 857-2070
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD 025833
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3085962
—
TN
05
—
3085969
—
TN
05
—
5644721
—
VA
Enumeration date
06/09/2005
Last updated
09/16/2009
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