Obstetrics & Gynecology of Dothan Inc
Organization Active NPI Obstetrics & Gynecology Physician · Dothan, AL
NPI 1114021409 · NPPES record last updated Dec 4, 2015
Key facts
- NPI
- 1114021409
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- License
- 26014 (AL)
- Legal business name
- OBSTETRICS & GYNECOLOGY OF DOTHAN INC
- Practice address
- 104 Medical Dr
Dothan, AL 36303 - Phone
- (334) 671-9445
- Fax
- (334) 836-0059
- NPI assigned
- Sep 8, 2006
- Organization subpart
- No
Authorized official
- Name
- Dana Gaylord
- Title
- Administrative Assistant
- Phone
- (334) 671-9445
Practitioners 27
-
Himanshu Aggarwal, M.D., M.S.
-
Lisa P Gowan, CNM
-
Asha Voss, MD
-
Jennyfer Watkins, NP
-
Antonia E Williams, D.O.
-
Emily Peterson, MD
-
Yocunda Clayton, M.D.
-
Marian Suzanne Gilliland, M.D.
-
Keltin Jimmerson, CRNP
-
Vicki Amanda Kelley, CRNP
-
Diane Klivington, DO, MS
-
Hayley Rebecca McDaniel, ARNP
-
Sharoi Victoria Powell, CRNP
-
Elaina G Sexton, M.D.
-
Candace N Short, CRNP
-
Donna E Connors, MD
-
Tia Guster, M.D.
-
Teki Susan Hegwood, M.D.
-
Sabrina Kelley, CRNP
-
Lisa M Malone, MD
-
Pamela Jones, CRNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040124000415 | AL | Part B Supplier - Clinic/Group Practice | 9436051877 |
Receives reassigned benefits from 24 practitioners Practice locations: Dothan, AL; Enterprise, AL |
National Provider Directory
Locations
1458 Whatley Dr
Dothan, AL 36303
Phone (334) 671-9445
847 Boll Weevil Cir
Ste 110
Enterprise, AL 36330
614 N Main St
Ste B
Enterprise, AL 36330
Phone (334) 348-8818
614 N Main St
Ste Bc
Enterprise, AL 36330
Phone (334) 671-9447
614 N Main St
#B
Enterprise, AL 36330
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician |
207V00000X | 23245 | AL | |
| Obstetrics & Gynecology Physician |
207V00000X | 26014 | AL | Yes |
| Obstetrics & Gynecology Physician |
207V00000X | DO1161 | AL | |
| Obstetrics & Gynecology Physician |
207V00000X | 31759 | AL | |
| Obstetrics & Gynecology Physician |
207V00000X | 31756 | AL | |
| Obstetrics & Gynecology Physician |
207V00000X | 32437 | AL | |
| Obstetrics & Gynecology Physician |
207V00000X | AL | ||
| Physician Assistant |
363A00000X | PA-204 | AL | |
| Obstetrics & Gynecology Nurse Practitioner |
363LX0001X | 1006758 | AL |
Addresses
Primary practice location
104 Medical Dr
Dothan, AL 36303
Mailing address
104 Medical Dr
Dothan, AL 36303
Phone (334) 671-9445
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01D2068157 | Other | CLIA WAVIER | |
| 01D0989955 | Other | CLIA WAIVED | |
| 1826 | Other | MEDICARE GROUP NUMBER | |
| C47766 | Other | MEDICAL PROTECTIVE | |
| 529928670 | Other | MEDICAID GROUP | |
| 01D2043043 | Other | AL | CLIA WAIVED |
| 051502953 | Medicaid | AL | |
| 01D2052896 | Other | AL | CLIA WAIVED |
| 01D2074304 | Other | CLIA WAIVED | |
| 051520983 | Medicaid | AL |
Other names
- Ladies First
Other providers in Dothan, AL
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- Robert Michael Obrien
- Occmed Solutions LLC
- Kenneth Franklin Odom
- Theresa Bryant Odum
- Osakpolor Ogbebor
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All providers in Dothan, AL · Obstetrics & Gynecology Physician in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 4, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.