MEDICARE: CHARA C MCLAUGHEN PA-C

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	363AM0700X	Medical Physician Assistant	1190	TN
2	363AM0700X	Medical Physician Assistant	1153	GA
3	367A00000X	Advanced Practice Midwife	PA001190	TN

General Provider Information

NPI Number	:	1912957614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARA C MCLAUGHEN PA-C

Provider Business Mailing Address
First Line	:	PO BOX 10988
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37939-0988
Country	:	US
Telephone Number	:	865-862-0998
Fax Number	:	865-544-1861

Provider Business Practice Location Address
First Line	:	353 WORTH ST NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37311-5074
Country	:	US
Telephone Number	:	423-339-0300
Fax Number	:	423-472-5687

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	02/07/2012

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