Healthcare Provider Details

I. General information

NPI: 1326464066
Provider Name (Legal Business Name): ENT SOUTH, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2014
Last Update Date: 01/15/2024
Certification Date: 01/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

PO BOX 8159
MOBILE AL
36689-0159
US

V. Phone/Fax

Practice location:
  • Phone: 334-793-6673
  • Fax: 334-792-0515
Mailing address:
  • Phone: 251-414-5810
  • Fax: 251-414-5809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: JEANETTE DOSTER
Title or Position: OFFICE MANAGER
Credential:
Phone: 334-793-6673