Healthcare Provider Details

I. General information

NPI: 1255466330
Provider Name (Legal Business Name): DERMATOLOGY ASSOCIATES OF DOTHAN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 02/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2431 W MAIN ST STE 501
DOTHAN AL
36301
US

IV. Provider business mailing address

2431 W MAIN ST STE 501
DOTHAN AL
36301-1274
US

V. Phone/Fax

Practice location:
  • Phone: 334-793-9222
  • Fax: 334-671-0322
Mailing address:
  • Phone: 334-793-9222
  • Fax: 334-671-0322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LEONARD T PYNES
Title or Position: OWNER
Credential: MD
Phone: 334-793-9222