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SOUTHERN CLINIC PC NPI 1053410480


NPI Information

NPI: 1053410480
Provider Name: SOUTHERN CLINIC PC
Classification: Internal Medicine - 207R00000X
Entity Type: Organization

CLIA Number: 01D0689512

Address:
1901 MELBA DR
DOTHAN, AL
ZIP 36301
Phone: (334) 794-6611
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SOUTHERN CLINIC PC is an internal medicine in Dothan, AL. The provider is a physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. SOUTHERN CLINIC PC NPI is 1053410480. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1901 MELBA DR
DOTHAN, AL
ZIP 36301-017
Phone: (334) 794-6611
Fax: (334) 794-6614

The provider's authorized official is Brian Holman .
The authorized official title is Office Administrator and has the following contact phone number (334) 794-6611.

The CLIA number assigned to this NPI record is 01D0689512 - physician office with a certificate type of Certificate of Accreditation.

The enumeration date for this NPI number is 9/22/2006 and was last updated on 2/1/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1363L00000XNurse PractitionerNo
2207R00000XInternal MedicineYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1D828MEDICARE PINALABAMA
2Q684OTHERALABAMABC/BS OF ALABAMA
3CL4538MEDICARE PINALABAMA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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