Organization Active NPI

Internal Medicine Associates of Dothan, P.a.

  • Internal Medicine Physician
  • Dothan, AL
National Provider Identifier
1336196682
Registry record updated Dec 16, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
INTERNAL MEDICINE ASSOCIATES OF DOTHAN, P.A.
Practice address
210 Westside Dr
Dothan, AL 36303-1928
Phone
(334) 793-5074
Fax
(334) 793-6460
NPI assigned
May 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2009

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

Authorized official

Name
Mr. George Wakefield
Title
Administrator
Phone
(334) 793-5074

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

210 Westside Dr
Dothan, AL 36303-1928

Mailing address

210 Westside Dr
Dothan, AL 36303-1928
Phone (334) 793-5074

Other identifiers 1

IdentifierTypeStateIssuer
529302970MedicaidAL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1148947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260921600000",
    "number": "1336196682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 WESTSIDE DR",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363031928",
            "telephone_number": "334-793-5074",
            "fax_number": "334-793-6460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 WESTSIDE DR",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363031928",
            "telephone_number": "334-793-5074",
            "fax_number": "334-793-6460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNAL MEDICINE ASSOCIATES OF DOTHAN, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-30",
        "last_updated": "2009-12-16",
        "status": "A",
        "authorized_official_last_name": "WAKEFIELD",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "334-793-5074",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529302970",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dothan, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.