Provider Demographics
NPI:1750729737
Name:CHOAT, HEATHER MCKENZIE (MD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MCKENZIE
Last Name:CHOAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-1980
Mailing Address - Country:US
Mailing Address - Phone:334-793-1881
Mailing Address - Fax:334-340-5918
Practice Address - Street 1:5565 MONTGOMERY HWY
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-1552
Practice Address - Country:US
Practice Address - Phone:334-699-3733
Practice Address - Fax:334-500-3007
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL35191208000000X, 2080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003217937CMedicaid
AL226795Medicaid
GA003217937DMedicaid
AL51220489OtherBCBS
FL102190000Medicaid
AL229006Medicaid
AL51220490OtherBCBS