Provider Demographics
NPI:1104067156
Name:SMITH, CHARLES ELTON (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:ELTON
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:C.
Other - Middle Name:E
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:M D LLC
Mailing Address - Street 1:107 SAINT FRANCIS ST
Mailing Address - Street 2:SUITE 2318
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36602-3334
Mailing Address - Country:US
Mailing Address - Phone:251-648-9791
Mailing Address - Fax:251-343-0289
Practice Address - Street 1:107 SAINT FRANCIS ST
Practice Address - Street 2:SUITE 2318
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36602-3334
Practice Address - Country:US
Practice Address - Phone:251-648-9791
Practice Address - Fax:251-343-0289
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL82002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL8200OtherMEDICAL LICENSE
ALCSMITIH345Medicaid