Provider Demographics
NPI:1104282292
Name:DOTHAN SPINE & SPECIALTY LLC
Entity type:Organization
Organization Name:DOTHAN SPINE & SPECIALTY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:WEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:334-793-1081
Mailing Address - Street 1:412 N FOSTER ST
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-4545
Mailing Address - Country:US
Mailing Address - Phone:334-793-1081
Mailing Address - Fax:334-792-7600
Practice Address - Street 1:412 N FOSTER ST
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-4545
Practice Address - Country:US
Practice Address - Phone:334-793-1081
Practice Address - Fax:334-792-7600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-06
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2089208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529928260Medicaid
AL529928260Medicaid
ALU74343Medicare UPIN