Provider Demographics
NPI:1306994611
Name:HUBBERT, CHARLES HUGHES (M D)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:HUGHES
Last Name:HUBBERT
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MEMPHIS VA HOSPITAL, DEPT. NEUROLOGY
Mailing Address - Street 2:1030 JEFFERSON AVENUE
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104
Mailing Address - Country:US
Mailing Address - Phone:901-577-8990
Mailing Address - Fax:901-577-7486
Practice Address - Street 1:MEMPHIS VA HOSPITAL, DEPT. NEUROLOGY
Practice Address - Street 2:1030 JEFFERSON AVENUE
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104
Practice Address - Country:US
Practice Address - Phone:901-577-8990
Practice Address - Fax:901-577-7486
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD54602084P0800X
TN54602084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN31020301OtherMEDICARE
TN4159798OtherBCBS OF TN
TN3102034Medicaid
TNB00392Medicare UPIN
TN3102034Medicaid