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General NPI Number Information
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NPI Number | 1427263227
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Entity Type | Organization
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Legal Business Name | SPECIALTY CLINIC, PC
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 10/02/2017
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Provider Practice Location Address
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Address Line | 508 E THREE NOTCH ST
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City | ANDALUSIA
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State | AL
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Zip | 36420-3128
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Country | US
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Telephone | 334-472-9427
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Fax | 334-222-2183
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Provider Business Mailing Address
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Address Line | PO BOX 310
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City | ANDALUSIA
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State | AL
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Zip | 36420-1205
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Country | US
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Telephone | 334-472-9427
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Fax | 334-222-2183
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Authorized Official
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Title or Position | OWNER, PHYSICIAN
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Name | DR. ROGER T BOYINGTON
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Credential | D.O.
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Telephone | 334-427-2273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO439
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License Number State | AL
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