Provider Demographics
NPI:1932300571
Name:DOTSON, JIMMIE LEE JR (MD)
Entity Type:Individual
Prefix:
First Name:JIMMIE
Middle Name:LEE
Last Name:DOTSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3680 GRANDVIEW PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-3411
Mailing Address - Country:US
Mailing Address - Phone:205-971-7500
Mailing Address - Fax:205-971-7571
Practice Address - Street 1:3680 GRANDVIEW PKWY STE 200
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-3411
Practice Address - Country:US
Practice Address - Phone:205-971-7500
Practice Address - Fax:205-971-7571
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21119208M00000X, 207P00000X
390200000X
AL33365207RI0011X
TN42681207R00000X
ALMD.33365207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2136488Medicaid
AL102I116917Medicare PIN
LA2136488Medicaid