SOUTHEAST ALABAMA ENT HEAD & NECK (NPI# 1528075447) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528075447 |
| Entity Type | Organization |
| Organization Name | SOUTHEAST ALABAMA ENT HEAD & NECK |
| Other Organization Name | ALABAMA ENT HEAD & NECK |
| Practice Address |
1118 Rose Clark Circle Ste 210 Dothan AL 36301 |
| Practice Telephone | 3347026900 |
| Practice Fax Number | 3346777749 |
| Mailing Telephone | 3347026900 |
| Mailing Fax Number | 3346777749 |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MRS. NANCY P WINDHAM (OFFICE ADMINISTRATOR) |
| Authorized Official Telephone | 3347026900 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207YX0905X |
Otolaryngology Specialization: Otolaryngology/Facial Plastic Surgery |
00025142 | AL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| BLUE CROSS | 51515841 | 01 |
| Other Name | Type Code |
|---|---|
| Alabama ENT Head & Neck | Doing Business As Name - Organization |
| Street Address |
1118 ROSE CLARK CIRCLE STE 210 |
| City | DOTHAN |
| State | AL |
| Zip Code | 36301 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043862931 | Pharmacy Center South LLC | Pharmacy | 2826 Ross Clark Circle, Suite 103, Dothan, AL 36301 | 2019-07-11 |
| 1851879167 | Attallah Cotton | Social Worker | 101 Eastridge Dr, Dothan, AL 36301 | 2018-07-31 |
| 1225522709 | Nichole Johnson Prestwood | Nurse Practitioner | 2431 W Main St Ste 501, Dothan, AL 36301 | 2018-06-19 |
| 1750805818 | Kimberly Danielle Austin | Speech-Language Pathologist | 404 Darlington Cir, Dothan, AL 36301 | 2017-07-31 |
| 1952794885 | Lori P. Granberry | Pharmacist | 2131 Ross Clark Circle, Dothan, AL 36301 | 2015-03-17 |
| 1801286059 | Robert Cody Russell | Nurse Practitioner | 1118 Ross Clark Circle, Suite 100, Dothan, AL 36301 | 2015-01-27 |
| 1720407646 | Michael Kreger | Anesthesiology | 1118 Ross Clark Cir Ste 700, Dothan, AL 36301 | 2014-04-08 |
| 1063851277 | Carlos Stanford Clark II | Family Medicine | 201 Doctors Drive, Dothan, AL 36301 | 2013-06-20 |
| 1639489313 | Robert Fort Hambaugh Jr. | Specialist | 712 Woodland Drive, Dothan, AL 36301 | 2010-10-15 |
| 1588894976 | Atwill Lamar Miller Jr. | Urology | 1908 Fairview Avenue, Dothan, AL 36301 | 2009-07-20 |
| Find all providers in zip 36301 | ||||
| Taxonomy Code | 207YX0905X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| Specialization | Otolaryngology/Facial Plastic Surgery |
| An otolaryngologist who specializes in the diagnosis and surgical treatment of head and neck conditions. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A General Certificate is issued by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710241054 | Ryan Gegg | Otolaryngology | 112 Haven Dr Ste 1, Dothan, AL 36301-2908 | 2012-07-02 |
| 1487728465 | John Christian Ferguson | Otolaryngology | 1118 Ross Clark Cir, Ste. 210, Dothan, AL 36301-3001 | 2006-11-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881019537 | South Otolaryngology-head and Neck Surgery, LLC | Otolaryngology | 2126 W Roy Parker Rd Ste 207, Ozark, AL 36360-8566 | 2014-03-04 |
| 1649523044 | Core Ent. LLC | Otolaryngology | 215 South 5th Street, Gadsden, AL 35901-4217 | 2012-10-23 |
| 1811913544 | Kurt W Kantzler | Otolaryngology | 215 S 5th St, Gadsden, AL 35901-4217 | 2006-07-14 |
| 1538195961 | Blane Edward Bateman | Otolaryngology | 901 Leighton Avenue, Suite 506, Anniston, AL 36207 | 2006-06-25 |
| 1497794945 | Marcus Moody | Otolaryngology | 2116 Data Park, Hoover, AL 35244-1203 | 2006-06-06 |
| 1063467447 | John H Rand | Otolaryngology | 80 Herren Hill Road, Ste D, Tallassee, AL 36078 | 2006-05-23 |
| 1477507408 | Mark L Hagood | Otolaryngology | 201 Whitesport Dr Sw, Huntsville, AL 35801-6449 | 2006-05-22 |
| 1316924798 | Salem K David Jr. | Otolaryngology | 1224 Mcfarland Blvd Ne, Suite A, Tuscaloosa, AL 35406-2287 | 2005-12-28 |
| 1528064201 | Keith A Kowal | Otolaryngology | 20308 Beecher St, Fairhope, AL 36532-3692 | 2005-06-27 |
| 1679940001 | Community Hospital Inc | Otolaryngology | 805 Friendship Rd, Tallassee, AL 36078-1234 | 2015-09-02 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.