Healthcare Provider Details

I. General information

NPI: 1093810863
Provider Name (Legal Business Name): CHARLES E ADAMS III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 W CLINCH AVE
KNOXVILLE TN
37916-2307
US

IV. Provider business mailing address

8209 PIMBROOK LN
KNOXVILLE TN
37923-6756
US

V. Phone/Fax

Practice location:
  • Phone: 865-541-1111
  • Fax: 865-539-8008
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD21040
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: