Healthcare Provider Details

I. General information

NPI: 1255335618
Provider Name (Legal Business Name): CHARISE BOWMAN JOHNS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 06/29/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 E PARKWAY
GATLINBURG TN
37738-5057
US

IV. Provider business mailing address

PO BOX 223
GATLINBURG TN
37738-0223
US

V. Phone/Fax

Practice location:
  • Phone: 865-412-1225
  • Fax: 865-412-1227
Mailing address:
  • Phone: 865-412-1225
  • Fax: 865-412-1227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35827
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: