Provider Demographics
NPI:1972798544
Name:NEUROLOGICAL ASSOCIATES OF DOTHAN
Entity Type:Organization
Organization Name:NEUROLOGICAL ASSOCIATES OF DOTHAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:WOODHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-793-6573
Mailing Address - Street 1:PO BOX 2247
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36302
Mailing Address - Country:US
Mailing Address - Phone:334-793-6573
Mailing Address - Fax:334-793-5346
Practice Address - Street 1:1118 ROSS CLARK CIRCLE
Practice Address - Street 2:STE 301
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301
Practice Address - Country:US
Practice Address - Phone:334-793-6573
Practice Address - Fax:334-793-5346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALH22365Medicare UPIN