Provider Demographics
NPI:1164450169
Name:NETTLES, FREDERICK ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:ALEXANDER
Last Name:NETTLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1075 DREWRY RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MONROEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36460-2840
Mailing Address - Country:US
Mailing Address - Phone:251-575-5988
Mailing Address - Fax:251-575-5970
Practice Address - Street 1:1075 DREWRY RD STE B
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36460-2839
Practice Address - Country:US
Practice Address - Phone:251-575-5988
Practice Address - Fax:251-575-5970
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00025726207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics