Individual
CHARLES GARRISON CLOUTIER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
461 E MAIN ST, PRATTVILLE, AL 36067-3409
(334) 351-2040
(334) 351-2047
Mailing address
PO BOX 681944, PRATTVILLE, AL 36068-1944
(334) 351-2040
(334) 351-2047
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
10751
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009952895
—
AL
01
—
011084
UNITED HEALTHCARE
AL
01
—
51013871
BLUE CROSS BLUE SHIELD
AL
Enumeration date
09/26/2005
Last updated
02/19/2020
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