Provider Demographics
NPI:1932114428
Name:ALABAMA SOUTH FAMILY PODIATRY P C
Entity Type:Organization
Organization Name:ALABAMA SOUTH FAMILY PODIATRY P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:COLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:334-678-7036
Mailing Address - Street 1:204 LUDS WAY
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-6350
Mailing Address - Country:US
Mailing Address - Phone:334-678-7036
Mailing Address - Fax:334-702-4208
Practice Address - Street 1:204 LUDS WAY
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-6350
Practice Address - Country:US
Practice Address - Phone:334-678-7036
Practice Address - Fax:334-702-4208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL77827OtherBLUE CROSS & BLUE SHIELD
AL1281950001Medicare NSC
AL000077827Medicare PIN
ALU70118Medicare UPIN