Healthcare Provider Details

I. General information

NPI: 1306205497
Provider Name (Legal Business Name): HOUSTON COUNTY HEALTHCARE AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2016
Last Update Date: 02/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 ROSS CLARK CIR SUITE 400A
DOTHAN AL
36301-4765
US

IV. Provider business mailing address

PO BOX 1928
DOTHAN AL
36302-1928
US

V. Phone/Fax

Practice location:
  • Phone: 334-794-4582
  • Fax: 334-671-9877
Mailing address:
  • Phone: 334-793-8087
  • Fax: 334-678-2895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT DEREK MILLER
Title or Position: CFO
Credential:
Phone: 334-793-8087