Healthcare Provider Details

I. General information

NPI: 1194556118
Provider Name (Legal Business Name): INFUSION CENTERS OF THE SOUTHEAST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 HAVEN DR
DOTHAN AL
36301-4016
US

IV. Provider business mailing address

PO BOX 8608
DOTHAN AL
36304-0608
US

V. Phone/Fax

Practice location:
  • Phone: 334-803-7401
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN HOVEY
Title or Position: DIRECTOR
Credential: MD
Phone: 334-479-8774