Healthcare Provider Details

I. General information

NPI: 1093679292
Provider Name (Legal Business Name): CHUC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 MEDICAL PARK DR STE 103
LENOIR CITY TN
37772-5782
US

IV. Provider business mailing address

216 CENTERVIEW DR STE 100
BRENTWOOD TN
37027-3226
US

V. Phone/Fax

Practice location:
  • Phone: 865-271-0038
  • Fax: 865-271-0040
Mailing address:
  • Phone: 615-656-2750
  • Fax: 314-270-3694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: TYLER TERWILLIGER
Title or Position: CREDENTILING SPECIALIST
Credential:
Phone: 615-656-2750