Basic Information
| Provider Information | |||||||||
| NPI: | 1689760704 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ABNEY | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | EUGENE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3611 WINDY RDG | ||||||||
| Address2: | |||||||||
| City: | TUSCALOOSA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 354063676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2057500860 | ||||||||
| FaxNumber: | 2053334660 | ||||||||
| Practice Location | |||||||||
| Address1: | 809 UNIVERSITY BLVD E | ||||||||
| Address2: | |||||||||
| City: | TUSCALOOSA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 354012029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2053334500 | ||||||||
| FaxNumber: | 2053334522 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2006 | ||||||||
| LastUpdateDate: | 03/20/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 21941 | AL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00269346 | 01 | MEDICARE RAILROAD | OTHER | 009933262 | 05 | AL | MEDICAID | 051531033 | 01 | AL | BCBS | OTHER | P00990323 | 01 | MEDICARE RAILROAD | OTHER | 127820 | 05 | AL | MEDICAID | 51116107 | 01 | AL | BLUE CROSS/BLUE SHIELD OF ALABAMA | OTHER |