CHARLES LEE JACKSON (NPI# 1942263793) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942263793 |
| Entity Type | Individual |
| Full Name | CHARLES LEE JACKSON |
| Credential | MD |
| Practice Address |
725 Glenwood Dr Ste E790 Chattanooga TN 37404-1178 |
| Practice Telephone | 4234953068 |
| Practice Fax Number | 4234953022 |
| Mailing Telephone | 4234953068 |
| Mailing Fax Number | 4234953022 |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2010-06-04 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | 41776 | TN | Allopathic & Osteopathic Physicians |
| N | 208800000X | Urology | ME0053658 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 044337900 | 05 | |
| TN | 1507399 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457896839 | Charles Jackson | Counselor | 2911 Penick St, Shreveport, LA 71109-4337 | 2016-12-21 |
| 1043655681 | Charles D Jackson | Driver | 4856 W.12th, Suite 1, Cleveland, OH 44109-3424 | 2013-05-09 |
| 1437594553 | Charles Jackson | Social Worker | 18712 Quarry St, Riverview, MI 48193-4527 | 2013-05-02 |
| 1508154105 | Charles Gilbert Jackson Jr. | Psychiatry & Neurology | 88 Crescent St, Northampton, MA 01060-2115 | 2011-07-16 |
| 1457669848 | Charles Edward Jackson Jr. | Psychologist | 1407 Healing Water Lane, N.las Vegas, NV 89031 | 2010-09-20 |
| 1588994081 | Charles Dustin Jackson | Counselor | 5004 Nw 26th St, Oklahoma City, OK 73127-1722 | 2010-01-05 |
| 1508985250 | Charles Arthur Jackson Jr. | Chiropractor | 2455 E Hill Rd, Grand Blanc, MI 48439 | 2007-03-27 |
| 1760535926 | Charles Jackson | Podiatrist | 820 N Dalmont St, Hobbs, NM 88240-5214 | 2007-01-19 |
| 1982769840 | Charles Jackson | Dentist | 3540 82nd St, Jackson Heights, NY 11372-5159 | 2006-12-22 |
| 1437224813 | Charles Wesley Jackson Jr. | Psychologist | 2980 Washington Blvd, Cleveland Heights, OH 44118-2450 | 2006-11-21 |
| Street Address |
725 GLENWOOD DR STE E790 |
| City | CHATTANOOGA |
| State | TN |
| Zip Code | 37404-1178 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659375491 | Collin G Cherry | Internal Medicine | 725 Glenwood Dr, Suite 480, Chattanooga, TN 37404-1163 | 2005-06-09 |
| 1942732938 | Dianne C. Roland, Md | Internal Medicine | 725 Glenwood Dr, Suite E688, Chattanooga, TN 37404-1163 | 2017-03-30 |
| 1356682066 | Maegen N Frizzell | Physician Assistant | 725 Glenwood Dr, Suite E-487, Chattanooga, TN 37404-1163 | 2013-03-05 |
| 1114299484 | Carrie Suzanne Durante | Physician Assistant | 725 Glenwood Dr, Memorial Missionary Ridge Tower, Ste 488, Chattanooga, TN 37404-1163 | 2012-02-02 |
| 1437464336 | Guru Padmakar Medam | Family Medicine | 725 Glenwood Dr, #e-788, Chattanooga, TN 37404-1163 | 2010-08-16 |
| 1568691509 | Alycia Cleinman | Internal Medicine | 725 Glenwood Dr, Suite E786, Chattanooga, TN 37404-1163 | 2009-07-13 |
| 1578723177 | Hisham Fozi Qutob | Internal Medicine | 725 Glenwood Dr, Suite E-500, Chattanooga, TN 37404-1163 | 2008-06-17 |
| 1386836070 | Liver and Gastroenterology Center | Internal Medicine | 725 Glenwood Dr, Memorial Medical Bldg East Suite 488e, Chattanooga, TN 37404-1163 | 2007-08-16 |
| 1912108598 | Andrew Pace Laramore | Pathology | 725 Glenwood Dr, Suite E-888, Chattanooga, TN 37404-1163 | 2007-05-30 |
| 1750504361 | Infectious Disease Physicians of Chattanooga, Pllc | Internal Medicine | 725 Glenwood Dr, Suite E-486, Chattanooga, TN 37404-1163 | 2007-04-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306494216 | Cynthia Caffey | Technician | 1305 E. 28th St. Apt A, Chatta, TN 37404 | 2019-09-04 |
| 1851944482 | Stacey Stokes | Peer Specialist | 1413 Bailey Ave, Chattanooga, TN 37404 | 2019-07-23 |
| 1306354790 | Erlanger Behavioral Health, LLC | Psychiatric Hospital | 804 North Holtzclaw Avenue, Chattanooga, TN 37404 | 2018-01-19 |
| 1245746171 | Davis Supportive Living Home Inc. | Custodial Care Facility | 1106 Duncan Avenue, Chattanooga, TN 37404 | 2017-12-14 |
| 1124544762 | Rachael Anne Maciver | Nurse Practitioner | 1909 South Willow Street, Chattanooga, TN 37404 | 2017-08-15 |
| 1447796214 | Esli Castillo | Nurse Practitioner | 281 N.lyerly St., Suite 200, Chattanooga, TN 37404 | 2017-01-17 |
| 1922542158 | Natasha Elliott | Community Health Worker | 2804 Cannon Ave, Chattanooga, TN 37404 | 2016-12-07 |
| 1730630153 | Jonathan Easter | Taxi | 1611 Anderson Avenue, Apt A, Chattanooga, TN 37404 | 2016-10-20 |
| 1477946143 | Thomas Jereme Holcomb | Nurse Practitioner | 281 N. Lyerly St, Suite 200, Chattanooga, TN 37404 | 2015-03-05 |
| 1922426709 | Sarah Mccary Baker | Internal Medicine | 605 Glenwood Drive, Suite 300, Chattanooga Internal Medicine Group, Chattanooga, TN 37404 | 2014-03-31 |
| Find all providers in zip 37404 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104232750 | Ringland Smith Murray | Urology | 1625 Edgewood Lane, Chattanooga, TN 37405 | 2014-07-03 |
| 1225263254 | Henry Tobechi Okafor | Urology | 979 E 3rd St Ste C-925, Chattanooga, TN 37403-2136 | 2009-05-19 |
| 1770650145 | Amar Singh | Urology | Academic Urologists At Erlanger, 979 East Third Street, Suit A450, Chattanooga, TN 37403 | 2006-11-29 |
| 1538138805 | John C House | Urology | 1300 Cleveland Ave, Chattanooga, TN 37404-2005 | 2006-03-17 |
| 1780680348 | Chattanooga Urology Associates | Urology | 725 Glenwood Drive, Suite #780, Chattanooga, TN 37404 | 2005-06-28 |
| 1104185396 | Jonathan Walker | Urology | 979 E 3rd St Ste C-925, Chattanooga, TN 37403 | 2012-05-09 |
| 1649537093 | Jessica Noelle Lange | Urology | 979 E 3rd St Ste C-925, Chattanooga, TN 37403 | 2012-04-23 |
| 1285945253 | Benjamin Tracy Waldorf | Urology | 979 E 3rd St Ste C-925, Chattanooga, TN 37403-2136 | 2010-06-24 |
| 1508038944 | Jeffrey K Mullins | Urology | 725 Glenwood Drive, Suite E790, Chattanooga, TN 37404 | 2008-03-26 |
| 1679752034 | Patrick H. Foley, M.d. | Urology | 2337 Mccallie Ave, Suite 407, Chattanooga, TN 37404-3257 | 2007-11-01 |
| Find all providers in CHATTANOOGA | ||||
| City | CHATTANOOGA |
| Zip Code | 37404 |
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| 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.