Provider Demographics
NPI:1528051133
Name:HENSLEIGH, CHARLES DAVID (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:DAVID
Last Name:HENSLEIGH
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:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:AL
Mailing Address - Zip Code:36251-0067
Mailing Address - Country:US
Mailing Address - Phone:256-354-4139
Mailing Address - Fax:256-354-4137
Practice Address - Street 1:83745 HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:AL
Practice Address - Zip Code:36251
Practice Address - Country:US
Practice Address - Phone:256-354-4139
Practice Address - Fax:256-354-4137
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9297207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051557552Medicaid
AL051557552Medicare ID - Type Unspecified
ALC72349Medicare UPIN