MR. CHARLES DAVID DIETZEN MD NPI 1417964248

NPI Information

  • NPI: 1417964248
  • Provider Name: MR. CHARLES DAVID DIETZEN, MD
  • Classification: General Practice - 208D00000X
  • Entity Type: Individual
  • Address: 4355 HIGHWAY 58
    SUITE 101
    CHATTANOOGA, TN
    ZIP 37416
  • Phone: (423) 892-4289

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NPI Details

MR. Charles David Dietzen, MD is a general practice in Chattanooga, TN. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee MR. Charles David Dietzen, MD NPI is 1417964248. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

4355 HIGHWAY 58
SUITE 101
CHATTANOOGA, TN
ZIP 37416-939
Phone: (423) 892-4289
Fax: (423) 892-8301

The enumeration date for this NPI number is 8/2/2006 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208D00000XGeneral Practice051638GEORGIANo
2208D00000XGeneral Practice009627TENNESSEEYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1B63029MEDICARE UPIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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