Provider Demographics
NPI:1700866233
Name:GENERAL SURGERY ASSOCIATES OF DOTHAN PC
Entity Type:Organization
Organization Name:GENERAL SURGERY ASSOCIATES OF DOTHAN PC
Other - Org Name:CHARLES J. CARPENTER, MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PRESIDEN
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:334-793-9564
Mailing Address - Street 1:4300 W MAIN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-1054
Mailing Address - Country:US
Mailing Address - Phone:334-793-9564
Mailing Address - Fax:334-671-8907
Practice Address - Street 1:4300 W MAIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1054
Practice Address - Country:US
Practice Address - Phone:334-793-9564
Practice Address - Fax:334-671-8907
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHARLES J CARPENTER, JR., MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-19
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17006208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529703840Medicaid
AL529703840Medicaid
AL000032574Medicare UPIN
AL529703840Medicaid