Organization
SOUTHERN CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN HOLMAN (OFFICE ADMINISTRATOR)
(334) 794-6611
Entity
Organization
Contact information
Practice address
1901 MELBA DR, DOTHAN, AL 36301-3017
(334) 794-6611
(334) 794-6614
Mailing address
1901 MELBA DR, DOTHAN, AL 36301-3017
(334) 794-6611
(334) 794-6614
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Q684
BC/BS OF ALABAMA
AL
Enumeration date
09/22/2006
Last updated
02/01/2008
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