Healthcare Provider Details

I. General information

NPI: 1831117514
Provider Name (Legal Business Name): CHARLES L HANEY PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1932 ALCOA HWY SUITE 255
KNOXVILLE TN
37920-1527
US

IV. Provider business mailing address

1932 ALCOA HWY SUITE 255
KNOXVILLE TN
37920-1527
US

V. Phone/Fax

Practice location:
  • Phone: 865-544-1869
  • Fax: 865-544-6533
Mailing address:
  • Phone: 865-544-1869
  • Fax: 865-544-6533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA02309
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1522
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: