Healthcare Provider Details

I. General information

NPI: 1659535557
Provider Name (Legal Business Name): CHARLES TESSIER IV DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 NW BROAD ST
MURFREESBORO TN
37129-1755
US

IV. Provider business mailing address

1340 NW BROAD ST
MURFREESBORO TN
37129-1755
US

V. Phone/Fax

Practice location:
  • Phone: 615-439-6165
  • Fax:
Mailing address:
  • Phone: 931-841-1777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO000001897
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1079
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: