Provider Demographics
NPI:1114959459
Name:WOOLDRIDGE, CHARLES (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:WOOLDRIDGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 KELLEY BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:MILLBROOK
Mailing Address - State:AL
Mailing Address - Zip Code:36054-2221
Mailing Address - Country:US
Mailing Address - Phone:334-245-2600
Mailing Address - Fax:334-245-2610
Practice Address - Street 1:101 KELLEY BLVD.
Practice Address - Street 2:SUITE D
Practice Address - City:MILLBROOK
Practice Address - State:AL
Practice Address - Zip Code:36054-2221
Practice Address - Country:US
Practice Address - Phone:334-245-2600
Practice Address - Fax:334-245-2610
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17565207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51556626WOOMedicare ID - Type Unspecified
F65871Medicare UPIN