Active NPI
Charles Gary Tomberlin, MD
- Diagnostic Radiology Physician
- Andalusia, AL
National Provider Identifier
1679539902
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 3233
- Practice address
- 848 S 3 Notch St
Andalusia, AL 36420-5320 - Phone
- (334) 222-5673
- Fax
- (334) 222-8754
- NPI assigned
- Apr 25, 2006
- Last updated
- May 21, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nuclear Radiology Physician | 2085N0904X | 3233 | AL | |
| Diagnostic Radiology Physician | 2085R0202X | 3233 | AL | Primary |
| Diagnostic Ultrasound Physician | 2085U0001X | 3233 | AL |
Addresses
Primary practice location
848 S 3 Notch St
Andalusia, AL 36420-5320
Mailing address
PO Box 27
Andalusia, AL 36420-1200
Phone (334) 222-5673
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000006385 | Medicaid | AL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3233 | AL | MD | Diagnostic Ultrasound Physician |
Interoperability endpoints
- https://api.platform.athenahealth.com/5021/brand/1/csg/1/fhir/r4
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145923200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211328000000",
"number": "1679539902",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 27",
"city": "ANDALUSIA",
"state": "AL",
"postal_code": "364201200",
"telephone_number": "334-222-5673",
"fax_number": "334-222-8754"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "848 S 3 NOTCH ST",
"city": "ANDALUSIA",
"state": "AL",
"postal_code": "364205320",
"telephone_number": "334-222-5673",
"fax_number": "334-222-8754"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TOMBERLIN",
"first_name": "CHARLES",
"middle_name": "GARY",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-04-25",
"last_updated": "2008-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "2085N0904X",
"taxonomy_group": "",
"desc": "Radiology, Nuclear Radiology",
"state": "AL",
"license": "3233",
"primary": false
},
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "AL",
"license": "3233",
"primary": true
},
{
"code": "2085U0001X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Ultrasound",
"state": "AL",
"license": "3233",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000006385",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Andalusia, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.