Basic Information
Provider Information | |||||||||
NPI: | 1164646238 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PARRISH | ||||||||
FirstName: | CHARLES | ||||||||
MiddleName: | ANDREW | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1010 AIRPARK CENTER DR | ||||||||
Address2: |   | ||||||||
City: | NASHVILLE | ||||||||
State: | TN | ||||||||
PostalCode: | 372175200 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6152214400 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 3918 MONTCLAIR RD | ||||||||
Address2: | SUITE 105 | ||||||||
City: | MOUNTAIN BRK | ||||||||
State: | AL | ||||||||
PostalCode: | 352132425 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2057053550 | ||||||||
FaxNumber: | 2057053554 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/12/2007 | ||||||||
LastUpdateDate: | 12/06/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 12/06/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ND0900X | ME100324 | FL | N |   | Allopathic & Osteopathic Physicians | Dermatology | Dermatopathology | 207ND0900X | M4422 | TX | N |   | Allopathic & Osteopathic Physicians | Dermatology | Dermatopathology | 207ND0900X | 060139 | GA | N |   | Allopathic & Osteopathic Physicians | Dermatology | Dermatopathology | 207ND0900X | 42811 | TN | N |   | Allopathic & Osteopathic Physicians | Dermatology | Dermatopathology | 207ND0900X | 49736 | CO | N |   | Allopathic & Osteopathic Physicians | Dermatology | Dermatopathology | 207ND0900X | 25MA08890200 | NJ | N |   | Allopathic & Osteopathic Physicians | Dermatology | Dermatopathology | 207ND0900X | 2592211 | NY | N |   | Allopathic & Osteopathic Physicians | Dermatology | Dermatopathology | 207ND0900X | A109974 | CA | N |   | Allopathic & Osteopathic Physicians | Dermatology | Dermatopathology | 207ND0900X | 0101245568 | VA | N |   | Allopathic & Osteopathic Physicians | Dermatology | Dermatopathology | 207ND0900X | 31499 | SC | N |   | Allopathic & Osteopathic Physicians | Dermatology | Dermatopathology | 207ND0900X | E5954 | AR | N |   | Allopathic & Osteopathic Physicians | Dermatology | Dermatopathology | 207ND0900X | 200800367 | NC | N |   | Allopathic & Osteopathic Physicians | Dermatology | Dermatopathology | 207ND0900X | 21341 | MS | N |   | Allopathic & Osteopathic Physicians | Dermatology | Dermatopathology | 207ND0900X | MD.201881 | LA | N |   | Allopathic & Osteopathic Physicians | Dermatology | Dermatopathology | 207ND0900X | 25063 | AL | Y |   | Allopathic & Osteopathic Physicians | Dermatology | Dermatopathology |
ID Information
ID | Type | State | Issuer | Description | 51136307 | 01 | AL | BLUE CROSS | OTHER |