Dothan Behavioral Medicine Clinic PC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

114222 Issued in AL

Legal business name

DOTHAN BEHAVIORAL MEDICINE CLINIC PC

Practice address

408 Healthwest Dr
Dothan, AL 36303-2054

Phone

(334) 479-0541

Fax

(334) 479-0586

NPI assigned

Nov 27, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Susannah Daughtry, B.S. PHARMACY

Title

Director of Pharmacy

Phone

(334) 796-1548

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Dothan Behavioral Medicine Clinic Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in AL

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Dothan Behavioral Medicine Clinic PC

  • Child & Adolescent Psychiatry Physician
  • Dothan, AL
  • NPI 1336277540

  6305833724

  Same PAC ID

Tax ID family

Dothan Behavioral Medicine Clinic PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Dothan Behavioral Medicine Clinic PC

  • Child & Adolescent Psychiatry Physician
  • Dothan, AL
  • NPI 1336277540
  NPD tax ID

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jerrika P. Myles, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Troy, AL
  • NPI 1972302537
  NPD
• Lakebra Scott, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Dothan, AL
  • NPI 1285432773
  NPD
• Elizabeth N Dosoretz, LCSW

  • Clinical Social Worker
  • Fort Myers, FL
  • NPI 1659565646
  NPD
• Mark Helmut Pichler, D.O.

  • Psychiatry Physician
  • Dothan, AL
  • NPI 1982652954
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1385510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484697600000",
    "number": "1295166346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 HEALTHWEST DR",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363032054",
            "telephone_number": "334-479-0541",
            "fax_number": "334-479-0586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 HEALTHWEST DR",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363032054",
            "telephone_number": "334-479-0541",
            "fax_number": "334-479-0586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOTHAN BEHAVIORAL MEDICINE CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-27",
        "last_updated": "2017-01-18",
        "status": "A",
        "authorized_official_last_name": "DAUGHTRY",
        "authorized_official_first_name": "SUSANNAH",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY",
        "authorized_official_telephone_number": "334-796-1548",
        "authorized_official_credential": "B.S. PHARMACY"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AL",
            "license": "114222",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2143097",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "154463",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dothan Behavioral Medicine Clinic Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mary E Donaldson, SLP
• Latonya L. Dorsey
• Dot MRI Radiology, PLLC
• Dothan Ambulance Service
• Dothan Anesthesiology Associates PC
• Dothan Behavioral Medicine Clinic PC
• Dothan Brace Shop
• Dothan Chiropractic Clinic, P.C.
• Dothan City
• Dothan Cosmetic Dentistry, PC

• Community/Retail Pharmacy in Dothan, AL
• Providers in Dothan, AL by specialty
• Community/Retail Pharmacy in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.