| Southern Lux And Metabolic Wellness | |
|
3332 W Main St Ste 2 Dothan AL 36305-1019 | |
| (719) 661-6033 | |
| Not Available |
| Full Name | Southern Lux And Metabolic Wellness |
|---|---|
| Speciality | Clinic/Center |
| Location | 3332 W Main St Ste 2, Dothan, Alabama |
| Authorized Official Name and Position | Kelley E Blake (CO-OWNER) |
| Authorized Official Contact | 7196616033 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Lux And Metabolic Wellness 1036 Mccord Rd Dothan AL 36301-8324 Ph: (719) 661-6033 | Southern Lux And Metabolic Wellness 3332 W Main St Ste 2 Dothan AL 36305-1019 Ph: (719) 661-6033 |
| NPI Number | 1427710896 |
|---|---|
| Provider Enumeration Date | 10/12/2021 |
| Last Update Date | 01/11/2023 |
| Medicare PECOS PAC ID | 5294121935 |
|---|---|
| Medicare Enrollment ID | O20220406002136 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427710896 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Philip T Wilson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811256084 PECOS PAC ID: 5294972386 Enrollment ID: I20130509000066 |
| Provider Name | Kelley E Blake |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770737249 PECOS PAC ID: 4981768694 Enrollment ID: I20151201003172 |
| Provider Name | Marcey Nicholas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972209153 PECOS PAC ID: 5092162651 Enrollment ID: I20231103002631 |
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