Provider Demographics
NPI:1528340536
Name:JONATHAN L SKINNER LLC
Entity type:Organization
Organization Name:JONATHAN L SKINNER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SURGEON - OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:SKINNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-699-0060
Mailing Address - Street 1:105 PROFESSIONAL LN
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-3875
Mailing Address - Country:US
Mailing Address - Phone:334-699-0060
Mailing Address - Fax:334-699-0061
Practice Address - Street 1:1118 ROSS CLARK CIR
Practice Address - Street 2:STE 302
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3001
Practice Address - Country:US
Practice Address - Phone:334-699-0060
Practice Address - Fax:334-699-0061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-15
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18574208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty