Provider Demographics
NPI:1548200371
Name:CHALELA, JULIO ALEJANDRO (MD)
Entity type:Individual
Prefix:
First Name:JULIO
Middle Name:ALEJANDRO
Last Name:CHALELA
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 746450
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6450
Mailing Address - Country:US
Mailing Address - Phone:866-401-3057
Mailing Address - Fax:318-868-6430
Practice Address - Street 1:6701 AIRPORT BLVD STE A203
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3763
Practice Address - Country:US
Practice Address - Phone:251-665-8290
Practice Address - Fax:251-410-4862
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC279652084A2900X, 2084N0400X
NC2020-029492084N0400X
ALMD.493262084A2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurocritical Care
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC279656Medicaid
SC279656Medicaid