Healthcare Provider Details

I. General information

NPI: 1881755619
Provider Name (Legal Business Name): CHARLES THOMAS NEVELS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CHARLES T NEVELS MD

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 09/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4406 OXFORD GATE
TUSCALOOSA AL
35405
US

IV. Provider business mailing address

PO BOX 40204
TUSCALOOSA AL
35404
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 TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number00025226
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: