Provider Demographics
NPI:1790798973
Name:KERR, CHARLES REID (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:REID
Last Name:KERR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 759
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-1214
Mailing Address - Country:US
Mailing Address - Phone:334-222-8450
Mailing Address - Fax:334-222-8066
Practice Address - Street 1:712 E THREE NOTCH ST
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-4004
Practice Address - Country:US
Practice Address - Phone:334-222-8450
Practice Address - Fax:334-222-8066
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15549207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALE38917Medicare UPIN