Provider Demographics
NPI:1972502334
Name:WINGARD, CHARLES S (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:S
Last Name:WINGARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 BROOKWOOD MEDICAL CTR DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6899
Mailing Address - Country:US
Mailing Address - Phone:205-397-8850
Mailing Address - Fax:205-397-8844
Practice Address - Street 1:2006 BROOKWOOD MEDICAL CTR DR
Practice Address - Street 2:SUITE 202
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6899
Practice Address - Country:US
Practice Address - Phone:205-397-8850
Practice Address - Fax:205-397-8844
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00006016174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC75101Medicare UPIN
AL000011247Medicare ID - Type Unspecified