Healthcare Provider Details

I. General information

NPI: 1992825889
Provider Name (Legal Business Name): CHARLES ROGER FREED JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5515 EDMONDSON PIKE SUITE 119-E
NASHVILLE TN
37211-5871
US

IV. Provider business mailing address

5515 EDMONDSON PIKE SUITE 119-E
NASHVILLE TN
37211-5871
US

V. Phone/Fax

Practice location:
  • Phone: 615-783-2648
  • Fax: 978-285-3016
Mailing address:
  • Phone: 615-783-2648
  • Fax: 978-285-3016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number33877
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number33877
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number33877
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: