Healthcare Provider Details

I. General information

NPI: 1255876181
Provider Name (Legal Business Name): HOUSTON COUNTY HEALTHCARE AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2017
Last Update Date: 05/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 W MAIN ST SUITE 1
DOTHAN AL
36305-1130
US

IV. Provider business mailing address

PO BOX 1928
DOTHAN AL
36302-1928
US

V. Phone/Fax

Practice location:
  • Phone: 334-446-4700
  • Fax: 334-446-4720
Mailing address:
  • Phone: 334-793-8087
  • Fax: 334-678-2895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT DEREK MILLER
Title or Position: CFO
Credential:
Phone: 334-793-8111