Provider Demographics
NPI:1396305579
Name:WOMEN'S HEALTHCARE OF DOTHAN, PC
Entity type:Organization
Organization Name:WOMEN'S HEALTHCARE OF DOTHAN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:E
Authorized Official - Last Name:NICHOLLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-793-6511
Mailing Address - Street 1:4300 W MAIN ST STE 31
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-1315
Mailing Address - Country:US
Mailing Address - Phone:334-793-6511
Mailing Address - Fax:334-702-6178
Practice Address - Street 1:4300 W MAIN ST STE 31
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1315
Practice Address - Country:US
Practice Address - Phone:334-793-6511
Practice Address - Fax:334-702-6178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Single Specialty