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1806 Fairview Ave Dothan AL 36301-3026 | |
| (334) 677-5986 | |
| (334) 677-4901 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 1806 Fairview Ave, Dothan, Alabama |
| Authorized Official Name and Position | Deborah S Woodham (CONTRACT MANAGER) |
| Authorized Official Contact | 3347938087 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 578 Dothan AL 36302-0578 Ph: (334) 677-5986 | 1806 Fairview Ave Dothan AL 36301-3026 Ph: (334) 677-5986 |
| NPI Number | 1023167962 |
|---|---|
| Provider Enumeration Date | 01/09/2007 |
| Last Update Date | 06/04/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023167962 | NPI | - | NPPES |
| 1023167962 | Medicaid | AL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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