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NPI Code Detail

MEDICARE: CHARLES E GAINES DO

MEDICARE: CHARLES E GAINES DO
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
12084P0800XPsychiatry PhysicianDO01281TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
24109591OTHERTNBCBS

General Provider Information

NPI Number : 1649236753
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES E GAINES DO
Provider Business Mailing Address
First Line : 403 N STATE OF FRANKLIN RD
Second Line :
City : JOHNSON CITY
State : TN
Zip : 37604-6034
Country : US
Telephone Number : 423-431-7013
Fax Number : 423-431-7130
Provider Business Practice Location Address
First Line : 403 N STATE OF FRANKLIN RD
Second Line :
City : JOHNSON CITY
State : TN
Zip : 37604-6034
Country : US
Telephone Number : 423-431-7013
Fax Number : 423-431-7130
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2006
Last Update Date : 07/08/2007

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Directions to “ CHARLES E GAINES DO” Practice Location

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