Healthcare Provider Details

I. General information

NPI: 1437825742
Provider Name (Legal Business Name): DERMATOLOGY AND SKIN HEALTH OF DOTHAN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 03/23/2022
Certification Date: 03/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 MEDICAL DRIVE
DOTHAN AL
36303
US

IV. Provider business mailing address

107 MEDICAL DRIVE
DOTHAN AL
36303
US

V. Phone/Fax

Practice location:
  • Phone: 334-500-3844
  • Fax: 334-828-7547
Mailing address:
  • Phone: 334-500-3844
  • Fax: 334-828-7547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AMANDA PITTS
Title or Position: OFFICE MANAGER
Credential:
Phone: 334-828-7546