MEDICARE: CHARLES T BRICE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	MD009287	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Q022086	OTHER	TN	TENNCARE

General Provider Information

NPI Number	:	1124029194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES T BRICE MD

Provider Business Mailing Address
First Line	:	979 E 3RD ST
Second Line	:	STE 300
City	:	CHATTANOOGA
State	:	TN
Zip	:	37403-2136
Country	:	US
Telephone Number	:	423-267-0466
Fax Number	:	423-757-0770

Provider Business Practice Location Address
First Line	:	979 E 3RD ST
Second Line	:	STE B 801
City	:	CHATTANOOGA
State	:	TN
Zip	:	37403-2136
Country	:	US
Telephone Number	:	423-267-2392
Fax Number	:	423-778-2433

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	07/11/2016

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Directions to “ CHARLES T BRICE MD” Practice Location

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