Healthcare Provider Details

I. General information

NPI: 1396305579
Provider Name (Legal Business Name): WOMEN'S HEALTHCARE OF DOTHAN, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2019
Last Update Date: 06/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 W MAIN ST STE 31
DOTHAN AL
36305-1315
US

IV. Provider business mailing address

4300 W MAIN ST STE 31
DOTHAN AL
36305-1315
US

V. Phone/Fax

Practice location:
  • Phone: 334-793-6511
  • Fax: 334-702-6178
Mailing address:
  • Phone: 334-793-6511
  • Fax: 334-702-6178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: CHRISTOPHER E NICHOLLS
Title or Position: MEDICAL DOCTOR
Credential: M.D.
Phone: 334-793-6511