Healthcare Provider Details

I. General information

NPI: 1790201903
Provider Name (Legal Business Name): GUT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 ROSS CLARK CIR STE 400
DOTHAN AL
36301-4770
US

IV. Provider business mailing address

480 HONEYSUCKLE RD
DOTHAN AL
36305-1156
US

V. Phone/Fax

Practice location:
  • Phone: 844-793-1380
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: ANDY FRANKLIN
Title or Position: ADMINISTRATOR
Credential:
Phone: 334-836-1052