Healthcare Provider Details

I. General information

NPI: 1972824993
Provider Name (Legal Business Name): S.B.J.S. PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2010
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 HEALTHWEST DR
DOTHAN AL
36303-2053
US

IV. Provider business mailing address

PO BOX 729
DOTHAN AL
36302-0729
US

V. Phone/Fax

Practice location:
  • Phone: 334-793-2663
  • Fax: 334-836-2248
Mailing address:
  • Phone: 334-793-2663
  • Fax: 334-836-2248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateAL

VIII. Authorized Official

Name: MILTON H WOOD
Title or Position: CEO
Credential:
Phone: 334-793-2663