Healthcare Provider Details

I. General information

NPI: 1023170461
Provider Name (Legal Business Name): ALABAMA ASTHMA & ALLERGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date: 06/13/2025
Reactivation Date: 08/08/2025

III. Provider practice location address

2826 ROSS CLARK CIR STE 304
DOTHAN AL
36301-2017
US

IV. Provider business mailing address

2826 ROSS CLARK CIR STE 304
DOTHAN AL
36301-2017
US

V. Phone/Fax

Practice location:
  • Phone: 334-794-2718
  • Fax: 334-671-1905
Mailing address:
  • Phone: 334-794-2718
  • Fax: 334-671-1905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number16176
License Number StateAL

VIII. Authorized Official

Name: SAMUEL ALTMAN
Title or Position: VP RCM
Credential: M.D.
Phone: 469-209-8355