Provider Demographics
NPI:1912992025
Name:MELVIN, CHARLES WAYNE (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:WAYNE
Last Name:MELVIN
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 1:234 KELLER PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:TUSCUMBIA
Mailing Address - State:AL
Mailing Address - Zip Code:35674-1417
Mailing Address - Country:US
Mailing Address - Phone:256-381-6963
Mailing Address - Fax:256-381-6018
Practice Address - Street 1:234 KELLER PARK BLVD
Practice Address - Street 2:
Practice Address - City:TUSCUMBIA
Practice Address - State:AL
Practice Address - Zip Code:35674-1417
Practice Address - Country:US
Practice Address - Phone:256-381-6963
Practice Address - Fax:256-381-6018
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10101208M00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51522529OtherBLUE CROSS BLUE SHIELD
AL009961925Medicaid
AL009961925Medicaid