Healthcare Provider Details

I. General information

NPI: 1154023620
Provider Name (Legal Business Name): JOSHUA CHARLES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 TAYLOR RD
MONTGOMERY AL
36117-3511
US

IV. Provider business mailing address

2677 DEER ST
MOHEGAN LAKE NY
10547-2019
US

V. Phone/Fax

Practice location:
  • Phone: 334-277-8330
  • Fax:
Mailing address:
  • Phone: 914-803-7069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number54574
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: