Healthcare Provider Details

I. General information

NPI: 1043284821
Provider Name (Legal Business Name): CHARLES M FREEMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 TUCKER STREET, SUITE 5 PROFESSIONAL ANESTHESIA ASSOCIATES
JACKSON TN
38301
US

IV. Provider business mailing address

410 N CEDAR BLUFF RD STE 300
KNOXVILLE TN
37923-3632
US

V. Phone/Fax

Practice location:
  • Phone: 931-388-6404
  • Fax: 931-388-7119
Mailing address:
  • Phone: 865-342-8900
  • Fax: 865-691-0843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberDO00729
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: