Provider Demographics
NPI:1063971091
Name:AZALEA BEHAVIORAL HEALTH PC
Entity type:Organization
Organization Name:AZALEA BEHAVIORAL HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CANDES
Authorized Official - Middle Name:
Authorized Official - Last Name:DOTSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:251-444-5868
Mailing Address - Street 1:4721 MORRISON DR STE 400
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-3350
Mailing Address - Country:US
Mailing Address - Phone:251-340-6947
Mailing Address - Fax:251-460-5457
Practice Address - Street 1:3929 AIRPORT BLVD STE 3-300
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-2235
Practice Address - Country:US
Practice Address - Phone:251-444-5868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-19
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1861713703OtherINDIVIDUAL NPI