Provider Demographics
NPI:1962890178
Name:DOTHAN INTERNAL MEDICINE, LLC
Entity type:Organization
Organization Name:DOTHAN INTERNAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:K
Authorized Official - Last Name:BEUACHAMP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-699-2004
Mailing Address - Street 1:1118 ROSS CLARK CIR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-3001
Mailing Address - Country:US
Mailing Address - Phone:334-699-2004
Mailing Address - Fax:334-699-2006
Practice Address - Street 1:1118 ROSS CLARK CIR
Practice Address - Street 2:SUITE 105
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3001
Practice Address - Country:US
Practice Address - Phone:334-699-2004
Practice Address - Fax:334-699-2006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20759174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1003831983OtherNPI INDIVIDUAL