Healthcare Provider Details

I. General information

NPI: 1811906126
Provider Name (Legal Business Name): CHARLES PEYTON COLVIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 09/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3686 GRANDVIEW PKWY 530
BIRMINGHAM AL
35243-3326
US

IV. Provider business mailing address

833 SAINT VINCENTS DR POB 3 SUITE 402
BIRMINGHAM AL
35205-1606
US

V. Phone/Fax

Practice location:
  • Phone: 205-933-9277
  • Fax: 205-212-3544
Mailing address:
  • Phone: 205-933-9236
  • Fax: 205-933-9213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number18817
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: