Healthcare Provider Details

I. General information

NPI: 1871587543
Provider Name (Legal Business Name): JAMES CHARLES ANDERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 CENTRAL PIKE STE 251
HERMITAGE TN
37076-3421
US

IV. Provider business mailing address

222 22ND AVE N
NASHVILLE TN
37203-1870
US

V. Phone/Fax

Practice location:
  • Phone: 629-255-2023
  • Fax: 629-255-4214
Mailing address:
  • Phone: 629-255-2023
  • Fax: 629-255-4214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD24705
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: