DR. CHARLES E GAMBLA (NPI# 1275573107) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275573107 |
| Entity Type | Individual |
| Full Name | DR. CHARLES E GAMBLA |
| Credential | MD |
| Practice Address |
4410 Watermelon Rd Northport AL 35473-5204 |
| Practice Telephone | 2053451520 |
| Practice Fax Number | 2053451761 |
| Mailing Telephone | 2053451520 |
| Mailing Fax Number | 2053451761 |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2010-09-28 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | 00023999 | AL | Allopathic & Osteopathic Physicians |
| N | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
00023999 | AL | Allopathic & Osteopathic Physicians |
| N | 207NS0135X |
Dermatology Specialization: Procedural Dermatology |
00023999 | AL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AL | 051504238 | 05 | |
| AL | BCBS | 051504238 | 01 |
| Street Address |
4410 WATERMELON RD |
| City | NORTHPORT |
| State | AL |
| Zip Code | 35473-5204 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669430872 | Karen Dietrich Walker | Dermatology | 4410 Watermelon Rd, Northport, AL 35473-5204 | 2006-05-04 |
| 1598381097 | Shelby S Warren | Nurse Practitioner | 4410 Watermelon Rd, Northport, AL 35473-5204 | 2020-06-19 |
| 1619462843 | Alicia O Holloway | Dermatology | 4410 Watermelon Rd, Northport, AL 35473-5204 | 2018-06-29 |
| 1821482464 | Adam Richardson | Dermatology | 4410 Watermelon Rd, Northport, AL 35473-5204 | 2015-03-21 |
| 1770993198 | Emily Gant Watson | Nurse Practitioner | 4410 Watermelon Rd, Northport, AL 35473-5204 | 2014-05-07 |
| 1912267550 | Staci Brown Hardwick | Nurse Practitioner | 4410 Watermelon Rd, Northport, AL 35473-5204 | 2012-05-16 |
| 1154331791 | Cynthia C Lucy | Dermatology | 4410 Watermelon Rd, Northport, AL 35473-5204 | 2006-08-08 |
| 1114968443 | Michael L Johnson | Dermatology | 4410 Watermelon Rd, Northport, AL 35473-5204 | 2006-06-09 |
| 1265472195 | Robert D Griffith | Dermatology | 4410 Watermelon Rd, Northport, AL 35473-5204 | 2006-06-08 |
| 1710928296 | David B Jackson | Dermatology | 4410 Watermelon Rd, Northport, AL 35473-5204 | 2006-06-08 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861002396 | Lacedric Crawford | Chore Provider | 13055 Garden Creek Lane, Northport, AL 35473 | 2020-08-10 |
| 1316585219 | Cerra Jordan Jackson | Family Medicine | 5710 Watermelon Road, Suite 600, Northport, AL 35473 | 2019-12-11 |
| 1033609748 | Kara Lynne Pate | Nurse Practitioner | 5710 Watermelon Rd Ste 600, Northport, AL 35473 | 2018-05-17 |
| 1134619059 | Vanessa Graves | Social Worker | 521 Energy Center Blvd Ste 1506, Northport, AL 35473 | 2018-05-16 |
| 1164930939 | Brandi Nail Hubbard | Family Medicine | 5004 Al-69, Northport, AL 35473 | 2018-01-16 |
| 1831554104 | Danielle Paulos | Pharmacist | 5137 Northcliff Dr, Northport, AL 35473 | 2015-12-30 |
| 1629497508 | Lauren Hanley | Nurse Practitioner | 4280 Watermelon Rd Ste 110, Northport, AL 35473 | 2014-04-08 |
| 1528372802 | Communication Advantage | Speech-Language Pathologist | 507 Energy Center Blvd Suite 301, West Al Speech Pathology, Northport, AL 35473 | 2010-07-29 |
| 1144467309 | Caroline J Day | Family Medicine | 5710 Watermelon Road, Suite 600, Northport, AL 35473 | 2009-01-09 |
| 1538311196 | Northridge Dialysis Center, LLC | Clinic/Center | 4400 Watermelon Road, Northport, AL 35473 | 2008-10-15 |
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| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669430872 | Karen Dietrich Walker | Dermatology | 4410 Watermelon Rd, Northport, AL 35473-5204 | 2006-05-04 |
| 1619462843 | Alicia O Holloway | Dermatology | 4410 Watermelon Rd, Northport, AL 35473-5204 | 2018-06-29 |
| 1821482464 | Adam Richardson | Dermatology | 4410 Watermelon Rd, Northport, AL 35473-5204 | 2015-03-21 |
| 1154331791 | Cynthia C Lucy | Dermatology | 4410 Watermelon Rd, Northport, AL 35473-5204 | 2006-08-08 |
| 1265440168 | Dennis Lance Spitz | Dermatology | 79 Middleville Rd, Northport, NY 11768-2200 | 2006-08-04 |
| 1114968443 | Michael L Johnson | Dermatology | 4410 Watermelon Rd, Northport, AL 35473-5204 | 2006-06-09 |
| 1265472195 | Robert D Griffith | Dermatology | 4410 Watermelon Rd, Northport, AL 35473-5204 | 2006-06-08 |
| 1710928296 | David B Jackson | Dermatology | 4410 Watermelon Rd, Northport, AL 35473-5204 | 2006-06-08 |
| 1538100011 | Jeffery C Weeks | Dermatology | 4410 Watermelon Rd, Northport, AL 35473-5204 | 2006-06-08 |
| 1841240363 | Catherine T. Lucas | Dermatology | 4410 Watermelon Rd, Northport, AL 35473-5204 | 2006-05-12 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.