Provider Demographics
NPI:1205833761
Name:MEAD, CHARLES MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:MICHAEL
Last Name:MEAD
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 1:502 MONTGOMERY HWY
Mailing Address - Street 2:STE 101
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216-1862
Mailing Address - Country:US
Mailing Address - Phone:205-823-0882
Mailing Address - Fax:205-823-0872
Practice Address - Street 1:502 MONTGOMERY HWY
Practice Address - Street 2:STE 101
Practice Address - City:VESTAVIA HILLS
Practice Address - State:AL
Practice Address - Zip Code:35216-1863
Practice Address - Country:US
Practice Address - Phone:205-823-0882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000171892085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051555108Medicaid
AL051531044OtherMEDICARE - GARDENDALE PHYSICIAN ASSOC.
AL051531585OtherMEDICARE - NORTH JEFFERSON IMAGING, LLC
AL051540087OtherMEDICARE - HORIZON IMAGING, PC
P00189169OtherRAILROAD MEDICARE
AL51524439OtherBCBS AL
AL051555108Medicaid
AL051555108Medicaid