Healthcare Provider Details

I. General information

NPI: 1508907684
Provider Name (Legal Business Name): CHARLES F ALBERT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 01/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 INDIAN SPRINGS DR
FLORENCE AL
35634-2056
US

IV. Provider business mailing address

210 INDIAN SPRINGS DR
FLORENCE AL
35634-2056
US

V. Phone/Fax

Practice location:
  • Phone: 256-810-3036
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number15691
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-063128
License Number StateAL

VIII. Authorized Official

Name: CHARLES ALBERT
Title or Position: OWNER
Credential: M.D.
Phone: 256-810-3036