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Organization
DECATUR ENT ASSOCIATES P C
Active
Organization
DECATUR ENT ASSOCIATES P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHONDRA CLARK (BILLING/INSURANCE)
(256) 355-6200
Entity
Organization
Contact information
Practice address
1218 13TH AVE SE, DECATUR, AL 35601-4307
(256) 355-6200
(256) 355-6241
Mailing address
1218 13TH AVE SE, DECATUR, AL 35601-4307
(256) 355-6200
(256) 355-6241
Taxonomy
Speciality
Code
Description
License number
State
207YS0123X
Facial Plastic Surgery Physician
Primary
—
NULL
207YS0123X
Facial Plastic Surgery Physician
Primary
—
—
207YX0602X
Otolaryngic Allergy Physician
—
NULL
207YX0602X
Otolaryngic Allergy Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
529001940
—
AL
01
—
CM6320
RAILROAD MEDICARE
AL
01
—
D380
BCBS OF AL GROUP#
AL
Enumeration date
04/18/2006
Last updated
02/20/2023
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