Healthcare Provider Details

I. General information

NPI: 1063971091
Provider Name (Legal Business Name): AZALEA BEHAVIORAL HEALTH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 05/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3929 AIRPORT BLVD STE 3-300
MOBILE AL
36609-2235
US

IV. Provider business mailing address

4721 MORRISON DR STE 400
MOBILE AL
36609-3350
US

V. Phone/Fax

Practice location:
  • Phone: 251-444-5868
  • Fax:
Mailing address:
  • Phone: 251-340-6947
  • Fax: 251-460-5457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. CANDES DOTSON
Title or Position: PRESIDENT/OWNER/DOCTOR
Credential: DO
Phone: 251-444-5868