Active NPI 1366629917 Individual Practitioner Male Practitioner

Dr. Jeffery L Walding , MD

Surgery - Plastic and Reconstructive Surgery • Dothan, AL

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Dr. Jeffery Walding, MD is a certified Surgery - Plastic and Reconstructive Surgery practicing in Dothan, AL. With approximately 22 years of clinical experience since graduating from University Of Alabama School Of Medicine in 2004, Dr. Walding delivers high-quality medical care to the local community at 3400 ROSS CLARK CIR.

Dr. Walding is affiliated with Southern Institute Of Plastic Surgery Inc and accepts Medicare assignment.

Frequently performed procedures and clinical services include axolotl dualgraft, per square centimeter, axolotl graft or axolotl dualgraft, per square centimeter, application of skin substitute graft to wound of trunk, arms, or legs, 25.0 sq cm or less of wound 100.0 sq cm or less. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

3400 Ross Clark Cir

Dothan, AL 363032525

Telephone 3346997477

Associated Practice Facility / Clinic

🏢 Southern Institute Of Plastic Surgery, Inc. Facility NPI 1154721983

Medicare Profile & Education

Medical School

University Of Alabama School Of Medicine

Graduation Year

2004

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Surgery - Plastic and Reconstructive Surgery in Dothan, AL

Senior Veteran Specialist (>20 Yrs)

Practitioner Clinical Experience

22 Yrs +1.5 yrs vs City Avg

City Avg: 20.5 Yrs

State Avg: 23.1 Yrs

Regional Practice Density

2 Specialists

Practicing in Dothan, AL (27 Statewide)

Telehealth Adoption Rate

0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

28.6% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Walding (22 Years) 22 Yrs

Dothan Specialty Average (20.5 Years) 20.5 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
Q4332 Axolotl dualgraft, per square centimeter	320	14	$1787.05	$1691.92
Q4210 Axolotl graft or axolotl dualgraft, per square centimeter	312	11	$1053.13	$834.44
15271 Application of skin substitute graft to wound of trunk, arms, or legs, 25.0 sq cm or less of wound 100.0 sq cm or less	64	15	$209.98	$127.88
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	63	54	$576.37	$366.86
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	59	45	$337.13	$121.45
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	38	32	$375.56	$136.69
15275 Application of skin substitute graft to wound of face, scalp, eyelids, mouth, neck, ears, around eyes, genitals, hands, feet, fingers, or toes, 25.0 sq cm or less of wound 100.0 sq cm or less	35	15	$220.00	$129.29
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	33	21	$77.96	$50.87
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	28	25	$633.27	$409.92
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	26	21	$545.63	$310.18
15004 Preparation of skin graft site of face, scalp, eyelids, mouth, neck, ears, around eyes, genitals, hands, feet, fingers, or toes, 100.0 sq cm or 1% body area for infants and children, or less	15	11	$528.81	$347.84

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
Q4158 Kerecis omega3, per square centimeter	603	11	$237.34	$152.43
Q4194 Novachor, per square centimeter	396	27	$1161.24	$1013.53
15271 Application of skin substitute graft to wound of trunk, arms, or legs, 25.0 sq cm or less of wound 100.0 sq cm or less	129	22	$283.55	$135.16
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	64	53	$787.87	$376.51
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	51	39	$452.47	$136.69
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	48	45	$876.83	$435.31
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	43	27	$104.92	$52.22
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	33	24	$517.53	$155.83
15275 Application of skin substitute graft to wound of face, scalp, eyelids, mouth, neck, ears, around eyes, genitals, hands, feet, fingers, or toes, 25.0 sq cm or less of wound 100.0 sq cm or less	24	16	$295.52	$141.36
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	17	16	$735.36	$333.34
11604 Removal of cancer skin growth of body, arms, or legs, 3.1-4.0 cm	13	12	$577.10	$198.19

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
Q4197 Puraply xt, per square centimeter	1,104	16	$403.85	$262.02
Q4194 Novachor, per square centimeter	321	15	$1210.44	$1021.70
15275 Application of skin substitute graft to wound of face, scalp, eyelids, mouth, neck, ears, around eyes, genitals, hands, feet, fingers, or toes, 25.0 sq cm or less of wound 100.0 sq cm or less	87	34	$322.44	$144.57
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	84	75	$970.19	$441.93
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	76	72	$858.61	$383.89
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	47	39	$496.49	$119.99
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	36	26	$112.85	$53.27
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	32	29	$571.71	$147.75
15004 Preparation of skin graft site of face, scalp, eyelids, mouth, neck, ears, around eyes, genitals, hands, feet, fingers, or toes, 100.0 sq cm or 1% body area for infants and children, or less	23	22	$519.45	$250.93
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	21	19	$822.71	$367.63
15260 Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)	17	17	$1655.54	$795.04
14060 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less	17	17	$1504.82	$723.00
11622 Removal of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	14	13	$523.14	$119.11
11102 Tangential biopsy of single skin lesion	14	13	$213.39	$82.16
14040 Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet by transferring skin, 10.0 sq cm or less	11	11	$1507.67	$714.24

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
Q4159 Affinity, per square centimeter	519	34	$1365.26	$677.46
15275 Application of skin substitute graft to wound of face, scalp, eyelids, mouth, neck, ears, around eyes, genitals, hands, feet, fingers, or toes, 25.0 sq cm or less of wound 100.0 sq cm or less	91	42	$382.71	$146.38
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	91	78	$1139.08	$450.50
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	73	64	$1029.31	$397.71
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	47	38	$585.86	$127.19
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	35	27	$133.59	$53.30
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	25	22	$668.15	$139.02
99213 Established patient office or other outpatient visit, typically 15 minutes	25	23	$218.48	$87.31
11102 Tangential biopsy of single skin lesion	24	23	$243.12	$78.93
13152 Complicated repair of wound of eyelids, nose, ears, or lip, 2.6-7.5 cm	23	23	$1206.58	$482.63
15004 Preparation of skin graft site of face, scalp, eyelids, mouth, neck, ears, around eyes, genitals, hands, feet, fingers, or toes, 100.0 sq cm or 1% body area for infants and children, or less	18	18	$639.95	$255.98
15260 Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)	18	18	$2032.33	$804.86
99202 New patient office or other outpatient visit, typically 20 minutes	18	18	$173.51	$69.43
11622 Removal of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	16	15	$605.28	$121.06
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	14	14	$962.28	$370.37

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
Q4159 Affinity, per square centimeter	973	53	$900.36	$643.74
Q4187 Epicord, per square centimeter	403	38	$434.37	$259.07
15275 Application of skin substitute graft to wound of face, scalp, eyelids, mouth, neck, ears, around eyes, genitals, hands, feet, fingers, or toes, 25.0 sq cm or less of wound 100.0 sq cm or less	137	76	$373.97	$145.51
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	95	94	$1128.26	$448.47
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	72	68	$1014.30	$398.63
99213 Established patient office or other outpatient visit, typically 15 minutes	69	56	$177.46	$70.60
99202 New patient office or other outpatient visit, typically 20 minutes	66	66	$179.21	$71.67
15271 Application of skin substitute graft to wound of trunk, arms, or legs, 25.0 sq cm or less of wound 100.0 sq cm or less	62	16	$355.06	$133.70
15260 Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)	61	58	$2316.42	$809.46
15004 Preparation of skin graft site of face, scalp, eyelids, mouth, neck, ears, around eyes, genitals, hands, feet, fingers, or toes, 100.0 sq cm or 1% body area for infants and children, or less	47	47	$841.74	$257.47
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	42	37	$581.48	$121.59
14060 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less	39	39	$1828.74	$708.36
13152 Complicated repair of wound of eyelids, nose, ears, or lip, 2.6-7.5 cm	33	33	$1194.22	$476.61
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	24	16	$106.51	$42.45
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	20	16	$664.46	$152.32
13122 Complicated repair of wound of scalp, arms, or legs, each additional 5.0 cm or less	19	11	$205.09	$81.85
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	18	18	$634.28	$237.94
11102 Tangential biopsy of single skin lesion	17	17	$232.89	$79.34
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	15	13	$389.59	$77.43
14041 Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet by transferring skin, 10.1-30.0 sq cm	12	12	$2199.88	$876.66
15260 Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)	11	11	$2379.14	$951.24

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
Q4160 Nushield, per square centimeter	1,611	89	$400.00	$167.88
Q4196 Puraply am, per square centimeter	500	11	$261.21	$102.81
Q4159 Affinity, per square centimeter	364	21	$900.00	$664.79
Q4187 Epicord, per square centimeter	299	31	$426.81	$264.83
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	227	204	$1117.28	$435.40
15275 Application of skin substitute graft to wound of face, scalp, eyelids, mouth, neck, ears, around eyes, genitals, hands, feet, fingers, or toes, 25.0 sq cm or less of wound 100.0 sq cm or less	199	119	$365.25	$131.54
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	98	91	$1001.58	$388.62
99213 Established patient office or other outpatient visit, typically 15 minutes	87	63	$174.70	$68.84
99202 New patient office or other outpatient visit, typically 20 minutes	80	80	$178.75	$70.43
15260 Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)	79	77	$2224.58	$800.44
15004 Preparation of skin graft site of face, scalp, eyelids, mouth, neck, ears, around eyes, genitals, hands, feet, fingers, or toes, 100.0 sq cm or 1% body area for infants and children, or less	67	67	$798.41	$251.79
13152 Complicated repair of wound of eyelids, nose, ears, or lip, 2.6-7.5 cm	59	57	$1185.35	$467.07
15271 Application of skin substitute graft to wound of trunk, arms, or legs, 25.0 sq cm or less of wound 100.0 sq cm or less	47	17	$346.16	$114.83
14060 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less	40	40	$1816.35	$706.76
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	38	30	$105.15	$41.00
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	33	21	$387.18	$76.29
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	32	25	$576.43	$124.22
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	28	27	$633.53	$236.26
11102 Tangential biopsy of single skin lesion	19	18	$227.83	$87.48
15120 Skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)	17	17	$1724.93	$647.87
14301 Repair of wound by transferring skin, 30.1-60.0 sq cm	16	16	$2519.03	$992.60
99201 New patient office or other outpatient visit, typically 10 minutes	14	13	$106.40	$41.93
15260 Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)	13	11	$2370.55	$898.16
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	12	12	$659.65	$140.80

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
Q4159 Affinity, per square centimeter	1,345	60	$900.00	$664.76
Q4160 Nushield, per square centimeter	1,104	76	$400.00	$208.61
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	236	212	$1319.34	$432.73
15275 Application of skin substitute graft to wound of face, scalp, eyelids, mouth, neck, ears, around eyes, genitals, hands, feet, fingers, or toes, 25.0 sq cm or less of wound 100.0 sq cm or less	155	86	$419.00	$135.76
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	97	82	$1182.00	$382.66
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	91	59	$121.99	$40.39
13152 Complicated repair of wound of eyelids, nose, ears, or lip, 2.6-7.5 cm	74	72	$1404.00	$461.15
15271 Application of skin substitute graft to wound of trunk, arms, or legs, 25.0 sq cm or less of wound 100.0 sq cm or less	74	30	$393.00	$127.31
15004 Preparation of skin graft site of face, scalp, eyelids, mouth, neck, ears, around eyes, genitals, hands, feet, fingers, or toes, 100.0 sq cm or 1% body area for infants and children, or less	70	70	$786.16	$252.81
15260 Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)	62	61	$2436.66	$801.24
99201 New patient office or other outpatient visit, typically 10 minutes	51	51	$124.00	$40.57
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	38	28	$688.00	$128.72
14060 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less	28	28	$2159.21	$714.80
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	25	19	$460.00	$76.35
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	25	24	$754.00	$220.39
11100 Biopsy of single growth of skin and/or tissue	24	21	$290.79	$90.24
14301 Repair of wound by transferring skin, 30.1-60.0 sq cm	22	22	$2984.64	$987.53
15120 Skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)	16	15	$1973.25	$646.44
99202 New patient office or other outpatient visit, typically 20 minutes	15	15	$209.00	$69.33
14301 Repair of wound by transferring skin, 30.1-60.0 sq cm	13	13	$2469.00	$819.18
15100 Partial thickness self skin graft to trunk, arms, or legs, 100.0 sq cm or 1% body area for infants and children, or less	12	12	$1989.00	$659.60
15260 Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)	12	12	$2815.00	$932.03
14041 Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet by transferring skin, 10.1-30.0 sq cm	11	11	$2618.00	$866.67
14061 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.1-30.0 sq cm	11	11	$2817.64	$932.10

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	257	225	$1325.98	$417.77
15004 Preparation of skin graft site of face, scalp, eyelids, mouth, neck, ears, around eyes, genitals, hands, feet, fingers, or toes, 100.0 sq cm or 1% body area for infants and children, or less	102	99	$776.03	$244.09
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	91	87	$1186.00	$355.46
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	89	68	$122.00	$38.33
13152 Complicated repair of wound of eyelids, nose, ears, or lip, 2.6-7.5 cm	86	85	$1412.00	$439.45
15275 Application of skin substitute graft to wound of face, scalp, eyelids, mouth, neck, ears, around eyes, genitals, hands, feet, fingers, or toes, 25.0 sq cm or less of wound 100.0 sq cm or less	69	58	$279.00	$77.15
15260 Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)	65	64	$2448.00	$766.64
99202 New patient office or other outpatient visit, typically 20 minutes	56	56	$210.00	$64.90
14060 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less	42	42	$2178.00	$680.59
14041 Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet by transferring skin, 10.1-30.0 sq cm	27	27	$2642.00	$835.91
15271 Application of skin substitute graft to wound of trunk, arms, or legs, 25.0 sq cm or less of wound 100.0 sq cm or less	23	18	$244.00	$50.81
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	22	22	$303.00	$95.94
14301 Repair of wound by transferring skin, 30.1-60.0 sq cm	22	21	$3014.00	$953.57
14061 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.1-30.0 sq cm	20	20	$2841.00	$898.80
15120 Skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)	18	18	$1978.00	$620.87
99201 New patient office or other outpatient visit, typically 10 minutes	16	16	$122.88	$38.75
99213 Established patient office or other outpatient visit, typically 15 minutes	15	13	$205.93	$65.20
14301 Repair of wound by transferring skin, 30.1-60.0 sq cm	14	14	$2510.00	$793.93
15260 Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)	12	12	$2839.00	$898.04
13151 Complicated repair of wound of eyelids, nose, ears, or lip, 1.1-2.5 cm	12	12	$1176.00	$356.63
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	12	11	$1098.00	$332.74
11100 Biopsy of single growth of skin and/or tissue	11	11	$286.00	$90.45

Medical Specialties & State Licenses

CMS Verified: 2023-09-14

Surgery - Plastic and Reconstructive Surgery Primary Specialty

NUCC Taxonomy Code: 2086S0122X

State License SC FW1724980

A surgeon who specializes in plastic and reconstructive surgery.

Hospital & Practice Group Affiliations

Southern Institute Of Plastic Surgery Inc

3400 Ross Clark Cir, Dothan, AL 363032525

Phone: 3346997477

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

1 Associated Practitioners

Dr. Scott Asher , MD

Plastic Surgery - Plastic Surgery Within the Head and Neck

NPI 1316109978

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

8 Historical Events

📍

Updated Practice Location September 14, 2023

Registered at 3400 ROSS CLARK CIR, DOTHAN, AL 363032525 (Tel: 3346997477)

📍

Updated Business Mailing Address September 14, 2023

Registered at 3400 ROSS CLARK CIR, DOTHAN, AL 363032525 (Tel: 3346997477)

✅

NPI Profile Active November 01, 2016

NPI status registered as active in NPPES database

📍

Updated Practice Location November 01, 2016

Registered at 2800 ROSS CLARK CIR STE 2, DOTHAN, AL 363019917 (Tel: 3346997477)

📍

Updated Business Mailing Address November 01, 2016

Registered at 2800 ROSS CLARK CIR STE 2, DOTHAN, AL 363019917 (Tel: 3346997477)

👤

Provider Name / Credentials Updated November 01, 2016

Recorded as JEFFERY WALDING, MD

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) November 01, 2016

Surgery (License #FW1724980 in SC)

🟢

Initial NPI Registration & Enumeration January 25, 2008

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

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NPI Administrative Meta

NPI Number: 1366629917

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: January 25, 2008

Last Update: September 14, 2023

Sole Proprietor: Yes

Update or Correct Profile

Mailing Address

3400 Ross Clark Cir

Dothan, AL 363032525

Phone: 3346997477

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

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