Healthcare Provider Details

I. General information

NPI: 1932132370
Provider Name (Legal Business Name): FAMILY PRACTICE CLINIC OF DOTHAN, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 E MAIN ST
DOTHAN AL
36301-3000
US

IV. Provider business mailing address

1245 WESTGATE PKWY
DOTHAN AL
36303-2151
US

V. Phone/Fax

Practice location:
  • Phone: 334-794-8771
  • Fax: 334-793-1578
Mailing address:
  • Phone: 334-793-9595
  • Fax: 334-793-1578

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: MRS. JOYCE HUFFAKER
Title or Position: PRACTICE MANAGER
Credential:
Phone: 334-793-9595