Active NPI 1881658664 Individual Practitioner Male Practitioner

Dr. Christopher C Thacker , MD

Urology • Cleveland, TN

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Dr. Christopher Thacker, MD is a certified Urology practicing in Cleveland, TN. With approximately 31 years of clinical experience since graduating from Emory University School Of Medicine in 1995, Dr. Thacker delivers high-quality medical care to the local community at 400 BERYWOOD TRL NW.

Dr. Thacker is affiliated with Tennessee Valley Urology Center Pc and accepts Medicare assignment.

Frequently performed procedures and clinical services include principal care management services for a single high-risk disease, first, ultrasound measurement of bladder capacity after voiding, established patient outpatient office visit. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

400 Berywood Trl Nw
Suite B

Cleveland, TN 373125287

Telephone 4234723201

Fax 4234764949

Associated Practice Facility / Clinic

🏢 Tennessee Valley Urology Center Pc Facility NPI 1538173232

Medicare Profile & Education

Medical School

Emory University School Of Medicine

Graduation Year

1995

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Urology in Cleveland, TN

Senior Veteran Specialist (>20 Yrs)

Practitioner Clinical Experience

31 Yrs +9.0 yrs vs City Avg

City Avg: 22.0 Yrs

State Avg: 24.0 Yrs

Regional Practice Density

7 Specialists

Practicing in Cleveland, TN (323 Statewide)

Telehealth Adoption Rate

42.9% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

44.6% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Thacker (31 Years) 31 Yrs

Cleveland Specialty Average (22.0 Years) 22.0 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99426 Principal care management services for a single high-risk disease, first 30 minutes of clinical staff time directed by health care professional, per calendar month	563	107	$75.00	$60.09
51798 Ultrasound measurement of bladder capacity after voiding	447	378	$25.23	$10.34
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	419	301	$250.18	$123.63
81002 Urinalysis, manual test	357	281	$15.00	$3.39
81000 Manual urinalysis test with examination using microscope, non-automated	306	223	$15.36	$3.94
99213 Established patient office or other outpatient visit, typically 15 minutes	168	151	$176.00	$87.41
99490 Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month	130	53	$75.00	$60.25
G2211 Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's	124	118	$29.96	$16.20
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	121	121	$324.00	$159.42
J9217 Leuprolide acetate (for depot suspension), 7.5 mg	72	12	$691.00	$177.07
52000 Diagnostic exam of bladder and urethra using an endoscope	71	63	$255.01	$226.43
J0696 Injection, ceftriaxone sodium, per 250 mg	68	17	$10.00	$0.46
99427 Principal care management services for a single high-risk disease, each additional 30 minutes of clinical staff time directed by health care professional, per calendar month	67	32	$60.00	$45.96
76872 Ultrasound scan of pelvic region through rectum	57	49	$131.00	$131.54
99439 Chronic care management services for two or more chronic conditions, additional 20 minutes of clinical staff time directed by health care professional, per calendar month	49	29	$60.00	$45.71
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	34	28	$43.00	$22.31
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	33	33	$259.00	$104.56
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	24	24	$263.00	$127.00
52356 Crushing of stone of ureter with insertion of stent using an endoscope	18	16	$450.01	$397.51
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	17	17	$350.00	$176.66
52332 Insertion of stent in urinary duct (ureter) using an endoscope	16	14	$556.25	$106.80
55700 Biopsy of prostate gland	14	14	$235.01	$230.23
96402 Administration of hormonal anti-neoplastic chemotherapy under skin or into muscle	12	12	$71.00	$33.16
52352 Removal or manipulation of stone in ureter or kidney using an endoscope	12	12	$402.00	$292.10
50590 Shock wave crushing of kidney stones	12	12	$955.18	$556.29

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J0897 Injection, denosumab, 1 mg	2,460	13	$32.21	$23.18
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	521	387	$243.06	$119.23
51798 Ultrasound measurement of bladder capacity after voiding	494	406	$25.21	$9.55
81002 Urinalysis, manual test	427	335	$15.00	$3.40
81000 Manual urinalysis test with examination using microscope, non-automated	347	245	$15.50	$3.90
J9217 Leuprolide acetate (for depot suspension), 7.5 mg	168	24	$691.00	$171.20
99213 Established patient office or other outpatient visit, typically 15 minutes	157	138	$167.11	$84.30
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	136	136	$319.55	$155.56
J0696 Injection, ceftriaxone sodium, per 250 mg	92	22	$10.00	$0.52
52000 Diagnostic exam of bladder and urethra using an endoscope	87	73	$257.83	$222.00
99490 Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month	79	42	$75.00	$58.89
76872 Ultrasound scan of pelvic region through rectum	51	48	$136.14	$124.86
99426 Principal care management services for a single high-risk disease, first 30 minutes of clinical staff time directed by health care professional, per calendar month	43	25	$75.00	$57.54
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	29	24	$42.17	$21.46
96402 Administration of hormonal anti-neoplastic chemotherapy under skin or into muscle	28	24	$71.00	$31.09
99439 Chronic care management services for two or more chronic conditions, additional 20 minutes of clinical staff time directed by health care professional, per calendar month	28	22	$60.00	$44.52
96401 Administration of non-hormonal anti-neoplastic chemotherapy under skin or into muscle	24	13	$135.24	$66.14
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	22	22	$245.92	$104.67
55700 Biopsy of prostate gland	19	19	$235.01	$224.12
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	18	18	$256.72	$123.46
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	16	16	$350.00	$168.77
52332 Insertion of stent in urinary duct (ureter) using an endoscope	14	12	$564.29	$95.29
52005 Insertion of tube into ureter using an endoscope through bladder area	12	11	$297.01	$89.72
52601 Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope	12	12	$1018.67	$655.50

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J0585 Injection, onabotulinumtoxina, 1 unit	2,200	11	$7.00	$6.14
51798 Ultrasound measurement of bladder capacity after voiding	583	472	$25.13	$9.45
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	503	378	$134.30	$121.14
81000 Manual urinalysis test with examination using microscope, non-automated	455	301	$15.39	$3.97
81002 Urinalysis, manual test	430	327	$15.00	$3.43
J9217 Leuprolide acetate (for depot suspension), 7.5 mg	201	25	$691.00	$173.62
99213 Established patient office or other outpatient visit, typically 15 minutes	201	177	$94.10	$85.71
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	140	140	$174.17	$157.52
52000 Diagnostic exam of bladder and urethra using an endoscope	117	103	$257.10	$226.71
J0696 Injection, ceftriaxone sodium, per 250 mg	64	16	$10.00	$0.50
52442 Insertion of implant in urethra within prostate gland using an endoscope, each additional implant	54	15	$1017.00	$47.63
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	35	31	$31.07	$21.65
76872 Ultrasound scan of pelvic region through rectum	34	34	$131.00	$131.11
96402 Administration of hormonal anti-neoplastic chemotherapy under skin or into muscle	34	25	$71.00	$30.75
52332 Insertion of stent in urinary duct (ureter) using an endoscope	23	20	$500.00	$118.56
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	19	19	$117.41	$102.66
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	17	17	$200.01	$188.22
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	16	16	$57.55	$53.11
55700 Biopsy of prostate gland	15	15	$235.01	$229.28
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	15	15	$186.85	$171.96
52441 Insertion of implant in urethra within prostate gland using an endoscope, 1 implant	15	15	$1396.67	$190.71
52287 Exam with injections of chemical for destruction of bladder using an endoscope	14	11	$310.00	$310.92
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	14	14	$75.20	$67.58
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	14	14	$150.01	$127.77
52310 Simple removal of foreign body, stone, or stent in urethra or bladder using an endoscope	11	11	$291.01	$292.13

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J0585 Injection, onabotulinumtoxina, 1 unit	2,100	11	$7.00	$6.07
51798 Ultrasound measurement of bladder capacity after voiding	511	420	$25.26	$9.27
81002 Urinalysis, manual test	450	368	$15.00	$3.47
81000 Manual urinalysis test with examination using microscope, non-automated	447	302	$15.50	$3.98
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	415	320	$133.88	$121.93
99213 Established patient office or other outpatient visit, typically 15 minutes	247	221	$92.73	$85.05
J9217 Leuprolide acetate (for depot suspension), 7.5 mg	237	31	$691.00	$178.46
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	151	151	$175.22	$157.63
52000 Diagnostic exam of bladder and urethra using an endoscope	119	107	$259.13	$219.16
J0696 Injection, ceftriaxone sodium, per 250 mg	72	18	$10.00	$0.53
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	67	54	$31.01	$21.27
96402 Administration of hormonal anti-neoplastic chemotherapy under skin or into muscle	40	31	$71.00	$30.30
52442 Insertion of implant in urethra within prostate gland using an endoscope, each additional implant	38	11	$1017.00	$48.87
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	33	33	$115.15	$106.37
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	33	33	$57.38	$53.12
76872 Ultrasound scan of pelvic region through rectum	23	22	$131.00	$130.51
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	23	23	$150.01	$129.62
52332 Insertion of stent in urinary duct (ureter) using an endoscope	22	19	$500.00	$122.38
55700 Biopsy of prostate gland	16	16	$235.01	$236.59
52287 Exam with injections of chemical for destruction of bladder using an endoscope	15	11	$310.00	$313.04
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	15	15	$184.06	$170.96
52441 Insertion of implant in urethra within prostate gland using an endoscope, 1 implant	11	11	$1396.67	$199.93
51741 Electronic assessment of bladder emptying	11	11	$117.01	$7.14

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
81000 Manual urinalysis test with examination using microscope, non-automated	451	257	$15.49	$3.96
81002 Urinalysis, manual test	349	280	$15.00	$3.46
99213 Established patient office or other outpatient visit, typically 15 minutes	293	258	$74.44	$70.69
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	250	203	$113.52	$103.40
51798 Ultrasound measurement of bladder capacity after voiding	215	172	$25.14	$9.30
J9217 Leuprolide acetate (for depot suspension), 7.5 mg	181	28	$691.00	$223.63
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	158	158	$165.56	$156.15
52000 Diagnostic exam of bladder and urethra using an endoscope	126	104	$256.95	$197.69
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	75	60	$31.02	$21.71
J0696 Injection, ceftriaxone sodium, per 250 mg	52	11	$10.00	$0.57
96402 Administration of hormonal anti-neoplastic chemotherapy under skin or into muscle	37	28	$71.00	$29.51
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	35	30	$145.01	$140.04
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	30	30	$52.08	$42.83
36415 Insertion of needle into vein for collection of blood sample	28	27	$16.15	$2.91
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	26	26	$150.01	$133.44
52332 Insertion of stent in urinary duct (ureter) using an endoscope	20	18	$525.00	$121.20
51702 Simple insertion of temporary bladder tube	17	16	$111.95	$57.85
99231 Follow-up hospital inpatient care per day, typically 15 minutes	13	12	$40.23	$38.33
76872 Ultrasound scan of pelvic region through rectum	12	12	$131.00	$132.41

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
81002 Urinalysis, manual test	436	347	$15.00	$3.38
81000 Manual urinalysis test with examination using microscope, non-automated	401	273	$21.54	$3.92
99213 Established patient office or other outpatient visit, typically 15 minutes	321	276	$89.18	$69.64
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	227	203	$135.42	$102.78
51798 Ultrasound measurement of bladder capacity after voiding	195	166	$34.92	$11.45
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	165	165	$184.16	$153.68
J9217 Leuprolide acetate (for depot suspension), 7.5 mg	162	23	$691.00	$218.85
52000 Diagnostic exam of bladder and urethra using an endoscope	95	74	$425.21	$176.54
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	52	46	$31.52	$20.92
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	38	36	$53.21	$42.25
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	28	27	$188.22	$138.33
51720 Instillation of anti-cancer drug into bladder	28	13	$233.58	$79.65
96402 Administration of hormonal anti-neoplastic chemotherapy under skin or into muscle	27	23	$71.00	$27.97
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	26	26	$165.39	$127.65
99205 New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more	13	13	$222.63	$196.21
52332 Insertion of stent in urinary duct (ureter) using an endoscope	13	11	$1053.85	$113.00
76872 Ultrasound scan of pelvic region through rectum	12	12	$251.08	$119.33
74420 Imaging of urinary tract	12	11	$121.33	$23.48
55700 Biopsy of prostate gland	11	11	$475.91	$235.84

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
81002 Urinalysis, manual test	652	487	$15.00	$3.40
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	358	289	$129.99	$100.68
81000 Manual urinalysis test with examination using microscope, non-automated	327	230	$21.29	$3.93
99213 Established patient office or other outpatient visit, typically 15 minutes	301	266	$86.77	$68.13
51798 Ultrasound measurement of bladder capacity after voiding	214	171	$33.76	$14.25
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	190	190	$180.88	$154.06
J9217 Leuprolide acetate (for depot suspension), 7.5 mg	121	18	$691.00	$212.48
52000 Diagnostic exam of bladder and urethra using an endoscope	112	95	$399.38	$151.28
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	84	76	$31.60	$19.81
51720 Instillation of anti-cancer drug into bladder	63	22	$210.43	$78.76
J9031 Bcg (intravesical) per instillation	61	21	$228.00	$134.46
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	56	53	$178.40	$136.26
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	35	34	$163.58	$129.78
52332 Insertion of stent in urinary duct (ureter) using an endoscope	27	23	$900.00	$105.23
96402 Administration of hormonal anti-neoplastic chemotherapy under skin or into muscle	21	18	$71.00	$28.28
51702 Simple insertion of temporary bladder tube	20	16	$148.20	$56.09
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	20	20	$53.20	$40.74
99231 Follow-up hospital inpatient care per day, typically 15 minutes	19	15	$51.50	$37.26
50590 Shock wave crushing of kidney stones	17	16	$2148.89	$539.16
76872 Ultrasound scan of pelvic region through rectum	15	15	$209.60	$89.71
52310 Simple removal of foreign body, stone, or stent in urethra or bladder using an endoscope	13	13	$450.08	$229.93
99205 New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more	13	13	$226.26	$193.83
52356 Crushing of stone of ureter with insertion of stent using an endoscope	13	12	$788.47	$401.39
52352 Removal or manipulation of stone in ureter or kidney using an endoscope	13	13	$993.23	$342.03
55700 Biopsy of prostate gland	13	13	$377.70	$232.61

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J0897 Injection, denosumab, 1 mg	1,320	11	$32.21	$16.61
81002 Urinalysis, manual test	579	449	$15.00	$3.42
81000 Manual urinalysis test with examination using microscope, non-automated	367	263	$15.62	$4.17
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	358	294	$113.37	$99.60
99213 Established patient office or other outpatient visit, typically 15 minutes	316	275	$74.56	$68.05
51798 Ultrasound measurement of bladder capacity after voiding	171	147	$25.09	$17.16
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	160	160	$166.10	$151.97
J9217 Leuprolide acetate (for depot suspension), 7.5 mg	132	20	$691.00	$207.66
52000 Diagnostic exam of bladder and urethra using an endoscope	110	92	$259.46	$151.05
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	56	53	$31.03	$18.65
51720 Instillation of anti-cancer drug into bladder	50	19	$160.45	$78.35
J9031 Bcg (intravesical) per instillation	47	19	$228.00	$119.08
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	46	44	$146.21	$135.39
99231 Follow-up hospital inpatient care per day, typically 15 minutes	36	20	$40.23	$37.17
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	33	33	$108.83	$100.20
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	25	24	$150.01	$129.69
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	25	25	$52.09	$40.29
99205 New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more	22	22	$203.03	$192.77
96402 Administration of hormonal anti-neoplastic chemotherapy under skin or into muscle	22	20	$71.00	$29.69
76872 Ultrasound scan of pelvic region through rectum	22	22	$131.00	$87.91
52332 Insertion of stent in urinary duct (ureter) using an endoscope	22	19	$500.00	$96.58
55700 Biopsy of prostate gland	17	17	$235.01	$229.54
74420 Imaging of urinary tract	16	14	$20.00	$17.03
76775 Limited ultrasound scan behind abdominal cavity	11	11	$112.32	$54.28

Medical Specialties & State Licenses

Urology Primary Specialty

NUCC Taxonomy Code: 208800000X

State License TN MD34911

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.

Hospital & Practice Group Affiliations

Tennessee Valley Urology Center Pc

400 Berywood Nwtrl B, Cleveland, TN 373125288

Phone: 4234723201

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

6 Associated Practitioners

Daniel Box

Urology

NPI 1083970198

Dr. Edward Mcintire , MD

Urology

NPI 1184689788

Doctor of Medicine (M.D.)

Joseph Ivey

Urology

NPI 1376079269

Dr. Stephen Jackson , MD

Urology

NPI 1386609808

Doctor of Medicine (M.D.)

Amanda Linden , FNP-C

Nurse Practitioner - Primary Care

NPI 1538544028

Family Nurse Practitioner (Certified)

Dr. Grant Simmons , MD

Urology

NPI 1982751921

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events

✅

NPI Profile Active October 23, 2007

NPI status registered as active in NPPES database

📍

Updated Practice Location October 23, 2007

Registered at 400 BERYWOOD TRL NW, SUITE B, CLEVELAND, TN 373125287 (Tel: 4234723201)

📍

Updated Business Mailing Address October 23, 2007

Registered at 400 BERYWOOD TRL NW, SUITE B, CLEVELAND, TN 373125287 (Tel: 4234723201)

👤

Provider Name / Credentials Updated October 23, 2007

Recorded as CHRISTOPHER THACKER, M.D.

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) October 23, 2007

Urology (License #MD34911 in TN)

🟢

Initial NPI Registration & Enumeration April 17, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1881658664

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: April 17, 2006

Last Update: October 23, 2007

Sole Proprietor: No

Update or Correct Profile

Mailing Address

400 Berywood Trl Nw, Suite B

Cleveland, TN 373125287

Phone: 4234723201

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.