Provider Demographics
NPI:1407913437
Name:GASTROENTEROLOGY ASSOCIATES OF DOTHAN, PC
Entity Type:Organization
Organization Name:GASTROENTEROLOGY ASSOCIATES OF DOTHAN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:GWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-836-1212
Mailing Address - Street 1:480 HONEYSUCKLE RD
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-1156
Mailing Address - Country:US
Mailing Address - Phone:334-836-1212
Mailing Address - Fax:334-836-1888
Practice Address - Street 1:480 HONEYSUCKLE RD
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1156
Practice Address - Country:US
Practice Address - Phone:334-836-1212
Practice Address - Fax:334-836-1888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALE427OtherMEDICARE GROUP PAYEE
AL=========OtherTAX ID NUMBER