Southeast Alabama ENT Head & Neck

Primary specialty

Otolaryngology/Facial Plastic Surgery PhysicianTaxonomy code 207YX0905X

License

00025142 Issued in AL

Legal business name

SOUTHEAST ALABAMA ENT HEAD & NECK

Practice address

1118 Rose Clark Circle
Ste 210
Dothan, AL 36301

Phone

(334) 702-6900

Fax

(334) 677-7749

NPI assigned

Aug 2, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Nancy P Windham

Title

Office Administrator

Phone

(334) 702-6900

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Alabama ENT Head & Neck Doing business as

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1528075447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1118 ROSE CLARK CIRCLE",
            "address_2": "STE 210",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "36301",
            "telephone_number": "334-702-6900",
            "fax_number": "334-677-7749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1118 ROSE CLARK CIRCLE",
            "address_2": "STE 210",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "36301",
            "telephone_number": "334-702-6900",
            "fax_number": "334-677-7749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST ALABAMA ENT HEAD & NECK",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WINDHAM",
        "authorized_official_first_name": "NANCY",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OFFICE ADMINISTRATOR",
        "authorized_official_telephone_number": "334-702-6900",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207YX0905X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "AL",
            "license": "00025142",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "51515841",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Alabama ENT Head & Neck",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Otolaryngology/Facial Plastic Surgery Physician in Dothan, AL
• Providers in Dothan, AL by specialty
• Otolaryngology/Facial Plastic Surgery Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.