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NPI Code Detail

MEDICARE: CHARLES DEPRIEST MD

MEDICARE: CHARLES DEPRIEST MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology PhysicianMD30698TN

General Provider Information

NPI Number : 1104911387
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES DEPRIEST MD
Provider Business Mailing Address
First Line : 1161 21ST AVE S
Second Line : VUMC DEPT OF RADIOLOGY CCC-1106 MCN
City : NASHVILLE
State : TN
Zip : 37232-0011
Country : US
Telephone Number : 615-343-1501
Fax Number : 615-343-8784
Provider Business Practice Location Address
First Line : 210 25TH AVE N STE 1204
Second Line :
City : NASHVILLE
State : TN
Zip : 37203-1620
Country : US
Telephone Number : 615-312-0600
Fax Number : 615-320-3259
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2006
Last Update Date : 08/26/2021

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