Healthcare Provider Details

I. General information

NPI: 1851715833
Provider Name (Legal Business Name): DOTHAN PAIN CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2014
Last Update Date: 02/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 WESTGATE PKWY SUITE 2
DOTHAN AL
36303-2963
US

IV. Provider business mailing address

318 WESTGATE PKWY SUITE 2
DOTHAN AL
36303-2963
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 TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number StateAL

VIII. Authorized Official

Name: DR. ROBERT SHEDDEN
Title or Position: OWNER
Credential: D.O.
Phone: 334-702-9445