Healthcare Provider Details

I. General information

NPI: 1801121504
Provider Name (Legal Business Name): SHEDDEN PAIN RELIEF & SPORTS MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2009
Last Update Date: 10/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1733 W MAIN ST SUITE 100
DOTHAN AL
36301-1330
US

IV. Provider business mailing address

PO BOX 8365
DOTHAN AL
36304-0365
US

V. Phone/Fax

Practice location:
  • Phone: 334-702-9445
  • Fax: 334-702-9465
Mailing address:
  • Phone: 334-702-9445
  • Fax: 334-702-9465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberDO118
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberDO118
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberDO118
License Number StateAL

VIII. Authorized Official

Name: MRS. PATRICIA D. SHEDDEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 334-702-9445