Healthcare Provider Details

I. General information

NPI: 1396840047
Provider Name (Legal Business Name): MEDICAL SPECIALTIES OF DOTHAN, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 HAVEN DRIVE
DOTHAN AL
36301
US

IV. Provider business mailing address

207 HAVEN DRIVE
DOTHAN AL
36301
US

V. Phone/Fax

Practice location:
  • Phone: 334-793-1964
  • Fax: 334-794-4131
Mailing address:
  • Phone: 334-793-1964
  • Fax: 334-794-4131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: JUDY FAYE WEST
Title or Position: OFFICE MANAGER
Credential:
Phone: 334-793-1964