Provider Demographics
NPI:1346314366
Name:CHARLES T NEVELS MD PC
Entity Type:Organization
Organization Name:CHARLES T NEVELS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:NEVELS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-556-8391
Mailing Address - Street 1:PO BOX 40204
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-0204
Mailing Address - Country:US
Mailing Address - Phone:205-556-8391
Mailing Address - Fax:205-553-3323
Practice Address - Street 1:4406 OXFORD GATE DR
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405-4767
Practice Address - Country:US
Practice Address - Phone:205-556-8391
Practice Address - Fax:205-553-3323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000252262084P0800X, 2084P0805X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K704Medicare ID - Type Unspecified