Provider Demographics
NPI:1336764125
Name:TOLBERT, CHARLITHA D
Entity Type:Individual
Prefix:
First Name:CHARLITHA
Middle Name:D
Last Name:TOLBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 FIELDSTOWN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071-2418
Mailing Address - Country:US
Mailing Address - Phone:205-240-5482
Mailing Address - Fax:
Practice Address - Street 1:5212 HAZELWOOD RD
Practice Address - Street 2:
Practice Address - City:ADAMSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35005-1738
Practice Address - Country:US
Practice Address - Phone:205-240-5482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00089872251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health