Provider Demographics
NPI:1174676308
Name:GIDDENS, CHARLES FRANKLIN (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:FRANKLIN
Last Name:GIDDENS
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 1:309 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-2421
Mailing Address - Country:US
Mailing Address - Phone:256-259-5313
Mailing Address - Fax:
Practice Address - Street 1:60 MAIN ST N
Practice Address - Street 2:
Practice Address - City:SECTION
Practice Address - State:AL
Practice Address - Zip Code:35771-7168
Practice Address - Country:US
Practice Address - Phone:256-228-3471
Practice Address - Fax:256-228-7289
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00008478207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051516401OtherBLUE CROSS BLUE SHIELD
AL051516404OtherBLUE CROSS BLUE SHIELD
AL105287Medicaid
AL630303040Medicaid
AL630306040Medicaid
AL630302040Medicaid
AL630309040Medicaid
AL630308040Medicaid
AL051516403OtherBLUE CROSS BLUE SHIELD
AL630307040Medicaid
AL051516405OtherBLUE CROSS BLUE SHIELD
AL105220Medicaid
AL051516400OtherBLUE CROSS BLUE SHIELD
AL051516402OtherBLUE CROSS BLUE SHIELD
AL102I087262Medicare PIN
AL630306040Medicaid