# DECATUR ENT ASSOCIATES P C

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

## Provider details

- **NPI number:** 1164487708
- **Authorized official:** SHONDRA CLARK (BILLING/INSURANCE)
- **Authorized official phone:** (256) 355-6200

## Contact information

- **Practice address:** 1218 13TH AVE SE, DECATUR, AL 35601-4307
- **Practice address phone:** (256) 355-6200
- **Practice address fax:** (256) 355-6241
- **Mailing address:** 1218 13TH AVE SE, DECATUR, AL 35601-4307
- **Mailing address phone:** (256) 355-6200
- **Mailing address fax:** (256) 355-6241

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207YS0123X | Facial Plastic Surgery Physician | — | NULL | Yes |
| 207YS0123X | Facial Plastic Surgery Physician | — | — | Yes |
| 207YX0602X | Otolaryngic Allergy Physician | — | NULL | — |
| 207YX0602X | Otolaryngic Allergy Physician | — | — | — |

## Other

- **Enumeration date:** 04/18/2006
- **Last updated:** 02/20/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 529001940 | — | AL |
| 01 | — | CM6320 | RAILROAD MEDICARE | AL |
| 01 | — | D380 | BCBS OF AL GROUP\# | AL |