Provider Demographics
NPI:1447369442
Name:ANDREWS, CHARLES RADFORD SR (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:RADFORD
Last Name:ANDREWS
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6027 WALNUT GROVE RD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2145
Mailing Address - Country:US
Mailing Address - Phone:901-761-5031
Mailing Address - Fax:901-761-5721
Practice Address - Street 1:6027 WALNUT GROVE RD
Practice Address - Street 2:SUITE 212
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2145
Practice Address - Country:US
Practice Address - Phone:901-761-5031
Practice Address - Fax:901-761-5721
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10103174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3382015Medicaid
TNB59466Medicare UPIN
TN3185703Medicare ID - Type Unspecified