Provider Demographics
NPI:1114070109
Name:DOUTHIT, GEORGE TIM
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:TIM
Last Name:DOUTHIT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 14TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-4314
Mailing Address - Country:US
Mailing Address - Phone:256-353-2021
Mailing Address - Fax:256-353-2093
Practice Address - Street 1:1317 14TH AVE SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-4314
Practice Address - Country:US
Practice Address - Phone:256-353-2021
Practice Address - Fax:256-353-2093
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11823183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0532650001Medicare ID - Type Unspecified