Provider Demographics
NPI:1528445145
Name:DOTHAN DIAGNOSTIC IMAGING RADIOLOGY, PLLC
Entity type:Organization
Organization Name:DOTHAN DIAGNOSTIC IMAGING RADIOLOGY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:W
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-792-1525
Mailing Address - Street 1:217 GRACELAND DR STE 4
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-7376
Mailing Address - Country:US
Mailing Address - Phone:334-792-1525
Mailing Address - Fax:
Practice Address - Street 1:217 GRACELAND DR STE 4
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-7376
Practice Address - Country:US
Practice Address - Phone:334-792-1525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-04
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty