Provider Demographics
NPI:1518912351
Name:WOMENS HEALTHCARE OF DOTHAN PC
Entity Type:Organization
Organization Name:WOMENS HEALTHCARE OF DOTHAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:E
Authorized Official - Last Name:NICHOLLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-793-6511
Mailing Address - Street 1:4300 W. MAIN
Mailing Address - Street 2:SUITE 31
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305
Mailing Address - Country:US
Mailing Address - Phone:334-793-6511
Mailing Address - Fax:334-793-4697
Practice Address - Street 1:4300 W. MAIN
Practice Address - Street 2:SUITE 31
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305
Practice Address - Country:US
Practice Address - Phone:334-793-6511
Practice Address - Fax:334-793-4697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0000157739174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL528201670Medicaid
D538Medicare PIN