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Organization
DOTHAN PEDIATRIC CLINIC, P. A.
Active
Organization
DOTHAN PEDIATRIC CLINIC, P. A.
Active
Other names
Enterprise Pediatric Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
GINA TOLAR (INSURANCE & COLLECTIONS SUPERVISOR)
(334) 793-1881
Entity
Organization
Contact information
Practice address
526 BOLL WEEVIL CIR, ENTERPRISE, AL 36330-4012
(334) 308-1166
Mailing address
126 CLINIC DR, DOTHAN, AL 36303-1980
(334) 793-1881
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LP0200X
Pediatric Nurse Practitioner
—
—
Other
Enumeration date
07/22/2021
Last updated
07/22/2021
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