Healthcare Provider Details

I. General information

NPI: 1497669261
Provider Name (Legal Business Name): CHARLES SHULTZ CCP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 MEDICAL CENTER DR
NASHVILLE TN
37232-0004
US

IV. Provider business mailing address

8573 GROVE PARK ST APT 612
BOWLING GREEN KY
42101-7721
US

V. Phone/Fax

Practice location:
  • Phone: 615-322-5000
  • Fax:
Mailing address:
  • Phone: 625-322-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number223374
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: