Provider Demographics
NPI:1225464332
Name:DOTY, GUY L JR (LICENSED)
Entity Type:Individual
Prefix:MR
First Name:GUY
Middle Name:L
Last Name:DOTY
Suffix:JR
Gender:M
Credentials:LICENSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:849 HIGHWAY 11
Mailing Address - Street 2:
Mailing Address - City:PETAL
Mailing Address - State:MS
Mailing Address - Zip Code:39465-2037
Mailing Address - Country:US
Mailing Address - Phone:601-545-2323
Mailing Address - Fax:601-545-3232
Practice Address - Street 1:849 HIGHWAY 11
Practice Address - Street 2:
Practice Address - City:PETAL
Practice Address - State:MS
Practice Address - Zip Code:39465-2037
Practice Address - Country:US
Practice Address - Phone:601-545-2323
Practice Address - Fax:601-545-3232
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMS0242237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSMS0242OtherLICENSED HEARING INSTRUMENT SPECIALIST