Provider Demographics
NPI:1114986791
Name:MCCAIN, CHARLES LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:LEE
Last Name:MCCAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 BALCH RD STE 250
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-8822
Mailing Address - Country:US
Mailing Address - Phone:256-704-2229
Mailing Address - Fax:256-704-2235
Practice Address - Street 1:1041 BALCH RD STE 250
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-8822
Practice Address - Country:US
Practice Address - Phone:256-704-2229
Practice Address - Fax:256-704-2235
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19625207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000026538Medicaid
AL000026541Medicaid
AL000026538Medicaid
AL26538Medicare ID - Type Unspecified
AL000026541Medicaid