Provider Demographics
NPI:1871190256
Name:THORN, CHARLES M (ARRT (RT) (CT))
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:M
Last Name:THORN
Suffix:
Gender:M
Credentials:ARRT (RT) (CT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 DEBBIE DR
Mailing Address - Street 2:
Mailing Address - City:DEATSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36022-2567
Mailing Address - Country:US
Mailing Address - Phone:334-669-4641
Mailing Address - Fax:
Practice Address - Street 1:204 DEBBIE DR
Practice Address - Street 2:
Practice Address - City:DEATSVILLE
Practice Address - State:AL
Practice Address - Zip Code:36022-2567
Practice Address - Country:US
Practice Address - Phone:334-669-4641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5663872085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology