Individual
CHARLES W BAGLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PNP
Contact information
Practice address
120 CRESCENT DR, COLLIERVILLE, TN 38017
(901) 757-3560
(901) 757-3563
Mailing address
8110 WALNUT RUN RD, CORDOVA, TN 38018
(901) 757-3550
(901) 757-3549
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
121342
TN
Other
Enumeration date
08/05/2006
Last updated
07/08/2007
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