Healthcare Provider Details

I. General information

NPI: 1750729737
Provider Name (Legal Business Name): HEATHER MCKENZIE CHOAT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2013
Last Update Date: 05/15/2020
Certification Date: 05/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5565 MONTGOMERY HWY
DOTHAN AL
36303-1552
US

IV. Provider business mailing address

126 CLINIC DR
DOTHAN AL
36303-1980
US

V. Phone/Fax

Practice location:
  • Phone: 334-699-3733
  • Fax: 334-500-3007
Mailing address:
  • Phone: 334-793-1881
  • Fax: 334-340-5918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35191
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number35191
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier003217937C
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer
# 2
Identifier226795
Identifier TypeMEDICAID
Identifier StateAL
Identifier Issuer
# 3
Identifier003217937D
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer
# 4
Identifier51220489
Identifier TypeOTHER
Identifier StateAL
Identifier IssuerBCBS
# 5
Identifier102190000
Identifier TypeMEDICAID
Identifier StateFL
Identifier Issuer
# 6
Identifier229006
Identifier TypeMEDICAID
Identifier StateAL
Identifier Issuer
# 7
Identifier51220490
Identifier TypeOTHER
Identifier StateAL
Identifier IssuerBCBS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: