Charles Theodore Reveley Jr., MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

MD.28076 Issued in AL

Practice address

400 Office Park Dr
Suite 110
Mountain BRK, AL 35223-3408

Phone

(205) 870-8415

NPI assigned

Jul 11, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• University of Alabama Health Services Foundation, PC.

  • Multi-Specialty Clinic/Center
  • Birmingham, AL
  • NPI 1093768723
  NPD (past)
• Richard H. Morse, MD a Prof. Med. Corp.

  • Interventional Pain Medicine Physician
  • New Orleans, LA
  • NPI 1922262112
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1333756800000",
    "number": "1245265982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 OFFICE PARK DR",
            "address_2": "SUITE 110",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352233408",
            "telephone_number": "205-870-8415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 OFFICE PARK DR",
            "address_2": "SUITE 110",
            "city": "MOUNTAIN BRK",
            "state": "AL",
            "postal_code": "352233408",
            "telephone_number": "205-870-8415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REVELEY",
        "first_name": "CHARLES",
        "middle_name": "THEODORE",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-11",
        "last_updated": "2012-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "AL",
            "license": "MD.28076",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC FEDERAL EHBP",
            "identifier": "051531152",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD",
            "identifier": "515-92203",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "051531151",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Virginia Paynter Rediker
• Pamela Boyd Reeve, RPH
• Amanda Regan, DPT
• Amanda B Reid, MA, ALC
• Reliatran LLC
• RH Al LLC (Ellie Mental Health)
• Hilarie Rhea
• Rheumatology Associates, P.C.
• Terry Rhoades, PT, DPT
• Ashlee Denise Rhodes

• Psychiatry Physician in Mountain BRK, AL
• Providers in Mountain BRK, AL by specialty
• Psychiatry Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.