Provider Demographics
NPI:1043463557
Name:DOTHAN NEURODIAGNOSTIC CENTER PC
Entity Type:Organization
Organization Name:DOTHAN NEURODIAGNOSTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-793-1703
Mailing Address - Street 1:1800 FAIRVIEW AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-3058
Mailing Address - Country:US
Mailing Address - Phone:334-793-1703
Mailing Address - Fax:334-793-9314
Practice Address - Street 1:1800 FAIRVIEW AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3058
Practice Address - Country:US
Practice Address - Phone:334-793-1703
Practice Address - Fax:334-793-9314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL113212084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty