Provider Demographics
NPI:1548953052
Name:CHARLES R TESSIER IV DO PC
Entity type:Organization
Organization Name:CHARLES R TESSIER IV DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:R
Authorized Official - Last Name:TESSIER
Authorized Official - Suffix:IV
Authorized Official - Credentials:DO
Authorized Official - Phone:931-841-1777
Mailing Address - Street 1:304 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37091-2730
Mailing Address - Country:US
Mailing Address - Phone:931-359-3551
Mailing Address - Fax:931-359-8421
Practice Address - Street 1:304 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:TN
Practice Address - Zip Code:37091-2730
Practice Address - Country:US
Practice Address - Phone:931-359-3551
Practice Address - Fax:931-359-8421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health