Provider Demographics
NPI:1942393913
Name:DOTHAN HEMATOLOGY & ONCOLOGY, P. C.
Entity Type:Organization
Organization Name:DOTHAN HEMATOLOGY & ONCOLOGY, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FULFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-792-9500
Mailing Address - Street 1:287 HEALTHWEST DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-2031
Mailing Address - Country:US
Mailing Address - Phone:334-792-9500
Mailing Address - Fax:334-793-1815
Practice Address - Street 1:287 HEALTHWEST DR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-2031
Practice Address - Country:US
Practice Address - Phone:334-792-9500
Practice Address - Fax:334-793-1815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529201430Medicaid
AL529000120Medicaid
ALD357Medicare PIN
ALI164Medicare PIN
ALCL0662Medicare PIN
AL529201430Medicaid
AL529000120Medicaid