Provider Demographics
NPI:1881755619
Name:NEVELS, CHARLES THOMAS (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:THOMAS
Last Name:NEVELS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHARLES
Other - Middle Name:T
Other - Last Name:NEVELS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 40204
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404
Mailing Address - Country:US
Mailing Address - Phone:205-556-8391
Mailing Address - Fax:205-553-3323
Practice Address - Street 1:4406 OXFORD GATE
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405
Practice Address - Country:US
Practice Address - Phone:205-556-8391
Practice Address - Fax:205-553-3323
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000252262084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051003682OtherBCBS
AL009928505Medicaid
AL051557088Medicare ID - Type Unspecified
H82104Medicare UPIN