Provider Demographics
NPI:1598731218
Name:SHUMATE, CHARLES RAYMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:RAYMOND
Last Name:SHUMATE
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 1:513 BROOKWOOD BLVD
Mailing Address - Street 2:SUITE 501
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6862
Mailing Address - Country:US
Mailing Address - Phone:205-930-8010
Mailing Address - Fax:205-930-8014
Practice Address - Street 1:513 BROOKWOOD BLVD
Practice Address - Street 2:SUITE 501
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6862
Practice Address - Country:US
Practice Address - Phone:205-930-8010
Practice Address - Fax:205-930-8014
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15764208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC69038Medicare UPIN
AL25665Medicare PIN