Provider Demographics
NPI:1326464066
Name:ENT SOUTH, PC
Entity Type:Organization
Organization Name:ENT SOUTH, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-793-6673
Mailing Address - Street 1:PO BOX 8159
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36689-0159
Mailing Address - Country:US
Mailing Address - Phone:251-414-5810
Mailing Address - Fax:251-414-5809
Practice Address - Street 1:4550 W MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1130
Practice Address - Country:US
Practice Address - Phone:334-793-6673
Practice Address - Fax:334-792-0515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-05
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty