Provider Demographics
NPI:1104944198
Name:CHARLES L. LETT, M D P C
Entity type:Organization
Organization Name:CHARLES L. LETT, M D P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:LEONARD
Authorized Official - Last Name:LETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-875-4374
Mailing Address - Street 1:1013 MEDICAL CENTER PKWY
Mailing Address - Street 2:BUILDING 1 SUITE A
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36701-6742
Mailing Address - Country:US
Mailing Address - Phone:334-875-4374
Mailing Address - Fax:334-875-4374
Practice Address - Street 1:1013 MEDICAL CENTER PKWY
Practice Address - Street 2:BUILDING 1 SUITE A
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-6742
Practice Address - Country:US
Practice Address - Phone:334-875-4374
Practice Address - Fax:334-875-4374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8713208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51002287OtherBLUE CROSS BLUE SHIELD
ALC70830Medicare UPIN
AL51002287OtherBLUE CROSS BLUE SHIELD