# MEDPEDS OF DOTHAN INC

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

## Provider details

- **NPI number:** 1427252766
- **Authorized official:** KRISTIN BOUTWELL (ADMINISTRATION)
- **Authorized official phone:** (334) 671-2895

## Contact information

- **Practice address:** 318 WESTGATE PKWY STE 2, DOTHAN, AL 36303-2963
- **Practice address phone:** (334) 671-2895
- **Practice address fax:** (334) 712-9430
- **Mailing address:** 318 WESTGATE PARKWAY STE 2, DOTHAN, AL 36303
- **Mailing address phone:** (334) 671-2895
- **Mailing address fax:** (334) 712-9430

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 00024928 | AL | Yes |
| 2080A0000X | Pediatric Adolescent Medicine Physician | 00024928 | AL | — |

## Other

- **Enumeration date:** 06/12/2007
- **Last updated:** 07/16/2007