Healthcare Provider Details

I. General information

NPI: 1346314366
Provider Name (Legal Business Name): CHARLES T NEVELS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 09/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4406 OXFORD GATE DR
TUSCALOOSA AL
35405-4767
US

IV. Provider business mailing address

PO BOX 40204
TUSCALOOSA AL
35404-0204
US

V. Phone/Fax

Practice location:
  • Phone: 205-556-8391
  • Fax: 205-553-3323
Mailing address:
  • Phone: 205-556-8391
  • Fax: 205-553-3323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number00025226
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number00025226
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number00025226
License Number StateAL

VIII. Authorized Official

Name: CHARLES THOMAS NEVELS
Title or Position: OWNER
Credential: MD
Phone: 205-556-8391