MEDICARE: CHARITI BLACK NP-C

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
1	363LF0000X	Family Nurse Practitioner	22769	TN

General Provider Information

NPI Number	:	1487164901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARITI BLACK NP-C

Provider Business Mailing Address
First Line	:	6802 LEE HWY
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-2444
Country	:	US
Telephone Number	:	423-313-3688
Fax Number	:	855-730-7240

Provider Business Practice Location Address
First Line	:	105 LEE PARKWAY DR STE A
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-6708
Country	:	US
Telephone Number	:	423-643-8000
Fax Number	:	855-730-7240

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2017
Last Update Date	:	02/03/2026

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