Provider Demographics
NPI:1053357673
Name:BARNETT, CHARLES (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:BARNETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3230 KELLER BEND RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-6525
Mailing Address - Country:US
Mailing Address - Phone:865-691-6759
Mailing Address - Fax:865-249-7638
Practice Address - Street 1:3230 KELLER BEND RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-6525
Practice Address - Country:US
Practice Address - Phone:865-691-6759
Practice Address - Fax:865-249-7638
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9608207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3167291Medicaid
B03223Medicare UPIN
TN3167291Medicare ID - Type Unspecified
TN3167291Medicaid
TN3717541Medicare ID - Type Unspecified