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General NPI Number Information
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NPI Number | 1134181456
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Entity Type | Organization
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Legal Business Name | ENT CARE PC
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Dates
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Enumeration Date | 04/03/2006
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Last Update Date | 04/22/2025
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Provider Practice Location Address
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Address Line | 4300 W MAIN ST SUITE 403
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City | DOTHAN
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State | AL
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Zip | 36305-1054
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Country | US
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Telephone | 334-793-4788
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Fax | 334-793-1561
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Provider Business Mailing Address
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Address Line | 4300 W MAIN ST SUITE 403
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City | DOTHAN
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State | AL
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Zip | 36305-1054
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Country | US
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Telephone | 334-793-4788
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Fax | 334-793-1561
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | TIMOTHY GANNON
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Credential |
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Telephone | 334-790-9620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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