Healthcare Provider Details

I. General information

NPI: 1669416855
Provider Name (Legal Business Name): CHRISTOPHER S ST. CHARLES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 SIGNAL POINT TRL
SIGNAL MOUNTAIN TN
37377-1839
US

IV. Provider business mailing address

106 SIGNAL POINT TRL
SIGNAL MOUNTAIN TN
37377-1839
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD23591
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: