Healthcare Provider Details

I. General information

NPI: 1801663711
Provider Name (Legal Business Name): CHARLES PARKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 SNOW ST STE C
OXFORD AL
36203-5402
US

IV. Provider business mailing address

1525 LEIGHTON AVE STE B
ANNISTON AL
36207-3805
US

V. Phone/Fax

Practice location:
  • Phone: 256-343-4080
  • Fax:
Mailing address:
  • Phone: 256-343-4080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberALC04699
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: