Provider Demographics
NPI:1912192238
Name:GAMMEL, CHARLES L (PHD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:L
Last Name:GAMMEL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6608 HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:MS
Mailing Address - Zip Code:39175-9226
Mailing Address - Country:US
Mailing Address - Phone:601-885-8001
Mailing Address - Fax:
Practice Address - Street 1:6608 HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:MS
Practice Address - Zip Code:39175-9226
Practice Address - Country:US
Practice Address - Phone:601-885-8001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA0370231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist