Provider Demographics
NPI:1972995603
Name:FISHER, CHARLES BRANDON (DO)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:BRANDON
Last Name:FISHER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:501 20TH ST STE 503
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1832
Mailing Address - Country:US
Mailing Address - Phone:865-331-4321
Mailing Address - Fax:865-331-4320
Practice Address - Street 1:501 20TH ST STE 503
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-1832
Practice Address - Country:US
Practice Address - Phone:865-331-4321
Practice Address - Fax:865-331-4320
Is Sole Proprietor?:No
Enumeration Date:2015-03-04
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN3621208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ046549Medicaid