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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
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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