Healthcare Provider Details

I. General information

NPI: 1932104809
Provider Name (Legal Business Name): CHARLES M EDDINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 03/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1772 S ALABAMA AVE
MONROEVILLE AL
36460-3062
US

IV. Provider business mailing address

75 HIGHWAY 136 W
MONROEVILLE AL
36460
US

V. Phone/Fax

Practice location:
  • Phone: 251-575-4825
  • Fax: 251-575-7730
Mailing address:
  • Phone: 251-575-4825
  • Fax: 251-575-7730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number00014732
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: