Provider Demographics
NPI:1508907684
Name:CHARLES F ALBERT
Entity Type:Organization
Organization Name:CHARLES F ALBERT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-810-3036
Mailing Address - Street 1:210 INDIAN SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35634-2056
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:210 INDIAN SPRINGS DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35634-2056
Practice Address - Country:US
Practice Address - Phone:256-810-3036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15691207R00000X
AL1-063128363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALI230OtherGROUP
01D0723250OtherCLIA
AL000083440Medicaid
AL1033180104OtherNPI
AL15691OtherSTATE LICENSE
AL1275629941OtherNPI
AL15691OtherSTATE LICENSE
AL000093251Medicare ID - Type Unspecified
AL000055674Medicare ID - Type Unspecified