# SOUTHEAST ALABAMA MATERNITY CARE PROGRAM

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104901438
- **Authorized official:** MR. GARY BENNETT (DIRECTOR)
- **Authorized official phone:** (334) 712-3784

## Contact information

- **Practice address:** 545 W MAIN ST STE 3, DOTHAN, AL 36301-1653
- **Practice address phone:** (334) 712-3784
- **Practice address fax:** (334) 712-3249
- **Mailing address:** PO BOX 6987, DOTHAN, AL 36302-6987
- **Mailing address phone:** (334) 712-3784
- **Mailing address fax:** (334) 712-3249

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302F00000X | Exclusive Provider Organization | — | NULL | Yes |

## Other

- **Enumeration date:** 10/26/2006
- **Last updated:** 08/22/2020