Individual
CHARLES RUSSELL ADCOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
520 E 12TH ST, SOUTH PITTSBURG, TN 37380-1633
(423) 837-7144
(423) 837-8428
Mailing address
520 E 12TH ST, SOUTH PITTSBURG, TN 37380-1633
(423) 837-7144
(423) 837-8428
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD011688
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0010013492
MEDICARE RAILROAD
TN
05
—
3723335
—
TN
Enumeration date
02/09/2006
Last updated
01/28/2009
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