Provider Demographics
NPI:1003403569
Name:DOTHAN PRIMARY CARE LLC
Entity Type:Organization
Organization Name:DOTHAN PRIMARY CARE LLC
Other - Org Name:DOTHAN FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIDAL
Authorized Official - Middle Name:
Authorized Official - Last Name:YUNIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-699-6396
Mailing Address - Street 1:PO BOX 242848
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36124-2848
Mailing Address - Country:US
Mailing Address - Phone:800-334-1757
Mailing Address - Fax:
Practice Address - Street 1:1891 HONEYSUCKLE RD STE 2A
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-4291
Practice Address - Country:US
Practice Address - Phone:334-794-6504
Practice Address - Fax:334-793-4452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-30
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty