Provider Demographics
NPI:1932104809
Name:EDDINS, CHARLES M (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:M
Last Name:EDDINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:75 HIGHWAY 136 W
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36460
Mailing Address - Country:US
Mailing Address - Phone:251-575-4825
Mailing Address - Fax:251-575-7730
Practice Address - Street 1:1772 S ALABAMA AVE
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36460-3062
Practice Address - Country:US
Practice Address - Phone:251-575-4825
Practice Address - Fax:251-575-7730
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00014732207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL080031628OtherRR MEDICARE #
AL86980OtherBC BS PROVIDER #
AL000086980Medicaid
AL000086980Medicaid
AL86980OtherBC BS PROVIDER #