MR. CHARLES DAVID DIETZEN (NPI# 1417964248) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417964248 |
| Entity Type | Individual |
| Full Name | MR. CHARLES DAVID DIETZEN |
| Credential | MD |
| Practice Address |
4355 Highway 58 Suite 101 Chattanooga TN 37416-2939 |
| Mailing Address |
2621 Crestwood Dr Chattanooga TN 37415-6321 |
| Practice Telephone | 4238924289 |
| Practice Fax Number | 4238928301 |
| Mailing Telephone | 4232663500 |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208D00000X | General Practice | 051638 | GA | Allopathic & Osteopathic Physicians |
| Y | 208D00000X | General Practice | 009627 | TN | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790756385 | Charles Joseph Dietzen | Physical Medicine & Rehabilitation | 705 Riley Hospital Dr, Ri 3146, Indianapolis, IN 46202-5109 | 2006-01-31 |
| Street Address |
4355 HIGHWAY 58 SUITE 101 |
| City | CHATTANOOGA |
| State | TN |
| Zip Code | 37416-2939 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942298732 | Joseph Motto | Otolaryngology | 4355 Highway 58, Suite 107a, Chattanooga, TN 37416-2939 | 2005-10-06 |
| 1609101823 | Henry Clayton Buhl | Dentist | 4355 Highway 58, Suite 110, Chattanooga, TN 37416-2939 | 2009-10-06 |
| 1619156908 | Joseph A. Motto, Md | Otolaryngology | 4355 Highway 58, Suite 107a, Chattanooga, TN 37416-2939 | 2007-11-02 |
| 1649477761 | Bettina Gardner | Nurse Practitioner | 4355 Highway 58, Suite 108, Chattanooga, TN 37416-2939 | 2007-07-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073170718 | A Pharmacy LLC | Pharmacy | 4767 Hwy 58, Suite 101, Chattanooga, TN 37416 | 2019-05-28 |
| 1639653835 | Paige Mayer | Pharmacist | 4542 Tn- 58, Chattanooga, TN 37416 | 2018-09-24 |
| 1528501517 | Tabitha Richelle Bell | Home Health | 6379 Plantation Dr, Chatt, TN 37416 | 2016-11-23 |
| 1588785109 | Mark Stephen Cowart | Dentist | 4355 Hwy 58, #103a, Chattanooga, TN 37416 | 2007-04-02 |
| 1558485334 | Robert Joseph Gallien | Dentist | 4620 Hwy 58, Chattanooga, TN 37416 | 2007-03-19 |
| 1154464782 | Carol Guess | Nurse Practitioner | 7380 Volkswagen Drive, Suite #110, Chattanooga, TN 37416 | 2007-02-14 |
| 1073615464 | Kristen Beeler Conner | Dentist | 4972 Highway 58 Ste 114, Chattanooga, TN 37416 | 2006-09-05 |
| 1003865536 | Stephen C Miller | Family Medicine | 7380 Volkswagon Drive, Suite 110, Chattanooga, TN 37416 | 2006-05-10 |
| 1740773241 | Nicholas Adam Jenkins | Physical Therapist | 7380 Volkswagen Dr Ste 190a, Chattanooga, TN 37416 | 2018-06-08 |
| 1639695034 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 4434 Highway 58, Chattanooga, TN 37416 | 2017-08-17 |
| Find all providers in zip 37416 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891202941 | One To One Health | General Practice | 1413 Mccallie Ave, Chattanooga, TN 37404-2936 | 2018-01-10 |
| 1417470501 | True Wellness Medical | General Practice | 6102 Shallowford Rd Ste 103, Chattanooga, TN 37421-1684 | 2017-07-20 |
| 1871914127 | Afc Physicians of Tennessee, PC | General Practice | 3520 Cummings Highway, Chattanooga, TN 37419-2311 | 2014-01-03 |
| 1447424866 | Comprehensive Health Services | General Practice | 3800 Amnicola Hwy, Chattanooga, TN 37406-1003 | 2008-04-16 |
| 1790789717 | Philip Thomas Newton Jr. | General Practice | 3812 Tennessee Ave, Chattanooga, TN 37409-1203 | 2005-06-08 |
| 1558836049 | Cascade Healthcare Pllc | General Practice | 6221 Shallowford Rd Ste 100, Chattanooga, TN 37421-1972 | 2018-10-10 |
| 1801276316 | Landmark Medical | General Practice | 103 Jordan Dr, Chattanooga, TN 37421-6715 | 2015-06-01 |
| 1346659810 | Apple Corporate Wellness Inc. | General Practice | 6221 Shallowford Rd, Ste 100, Chattanooga, TN 37421-1971 | 2014-08-08 |
| 1346654449 | Mh Health Care Services, PC | General Practice | 620 E 11th St, C/o City of Chattanooga Employee Health Center, Chattanooga, TN 37403-3101 | 2014-06-17 |
| 1962662791 | Urgent & General Medicine Ministry, PC | General Practice | 2158 Northgate Park Ln, Suite 104, Chattanooga, TN 37415-6957 | 2008-06-16 |
| Find all providers in CHATTANOOGA | ||||
| City | CHATTANOOGA |
| Zip Code | 37416 |
Please comment or provide details below to improve the information on MR. CHARLES DAVID DIETZEN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.