Provider Demographics
NPI:1174676977
Name:CHARLES B. LOVELADY, M.D., P.C.
Entity type:Organization
Organization Name:CHARLES B. LOVELADY, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-751-9055
Mailing Address - Street 1:301 PINE ST NW
Mailing Address - Street 2:SUITE D
Mailing Address - City:HARTSELLE
Mailing Address - State:AL
Mailing Address - Zip Code:35640-2338
Mailing Address - Country:US
Mailing Address - Phone:256-751-9055
Mailing Address - Fax:256-751-9135
Practice Address - Street 1:301 PINE ST NW
Practice Address - Street 2:SUITE D
Practice Address - City:HARTSELLE
Practice Address - State:AL
Practice Address - Zip Code:35640-2338
Practice Address - Country:US
Practice Address - Phone:256-751-9055
Practice Address - Fax:256-751-9135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13720174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC70203Medicare UPIN