Individual
CHARLES TYLER THACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
975 E 3RD ST, CHATTANOOGA, TN 37403-2173
(423) 778-7628
Mailing address
975 E 3RD ST, CHATTANOOGA, TN 37403-2173
(423) 778-7628
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
6328
TN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/03/2023
Last updated
08/25/2025
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