Individual
CHARLES DAVID ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3 PROFESSIONAL PARK DR, SUITE 21, JOHNSON CITY, TN 37604-6529
(423) 434-6300
(423) 434-6312
Mailing address
3 PROFESSIONAL PARK DR, SUITE 21, JOHNSON CITY, TN 37604-6529
(423) 434-6300
(423) 434-6312
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
147
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3665019
—
TN
Enumeration date
01/26/2006
Last updated
03/26/2008
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