Provider Demographics
NPI:1487726626
Name:PRIMECARE OF DOTHAN, PC
Entity type:Organization
Organization Name:PRIMECARE OF DOTHAN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:STEVE
Authorized Official - Last Name:SHERRER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:334-793-2120
Mailing Address - Street 1:PO BOX 8397
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36304-0397
Mailing Address - Country:US
Mailing Address - Phone:334-793-2120
Mailing Address - Fax:334-671-0228
Practice Address - Street 1:301 WESTGATE PKWY
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-2962
Practice Address - Country:US
Practice Address - Phone:334-793-2120
Practice Address - Fax:334-671-0228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL=========OtherTAX ID #