Provider Demographics
NPI:1174829089
Name:CHARLES B. LOVELADY, M.D., L.L.C.
Entity Type:Organization
Organization Name:CHARLES B. LOVELADY, M.D., L.L.C.
Other - Org Name:CHARLES B LOVELADY MD
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVELADY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-259-4817
Mailing Address - Street 1:PO BOX 1050
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-1050
Mailing Address - Country:US
Mailing Address - Phone:256-218-3856
Mailing Address - Fax:256-218-3536
Practice Address - Street 1:509 BURLINGTON ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-4216
Practice Address - Country:US
Practice Address - Phone:256-259-4817
Practice Address - Fax:256-259-2075
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JACKSON COUNTY HEALTHCARE AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-10
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD13720208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51049416OtherBLUE CROSS
AL112843Medicaid
ALC70203Medicare UPIN