Organization
ALABAMA SOUTH FAMILY PODIATRY P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY DIANE COLLIER DPM (PODIATRIST/OWNER)
(334) 678-7036
Entity
Organization
Contact information
Practice address
204 LUDS WAY, DOTHAN, AL 36303-6350
(334) 678-7036
(334) 702-4208
Mailing address
204 LUDS WAY, DOTHAN, AL 36303-6350
(334) 678-7036
(334) 702-4208
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
77827
BLUE CROSS & BLUE SHIELD
AL
Enumeration date
07/31/2006
Last updated
09/30/2016
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