| Wiregrass Clinic LLC | |
|
4300 W Main St Ste 405 Dothan AL 36305-1086 | |
| (334) 944-7073 | |
| (334) 944-7058 |
| Full Name | Wiregrass Clinic LLC |
|---|---|
| Speciality | Family Medicine |
| Location | 4300 W Main St Ste 405, Dothan, Alabama |
| Authorized Official Name and Position | Jennifer L Jackson (SR DIR PROV ENROLLMENT & ONBOARDING) |
| Authorized Official Contact | 6154653334 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wiregrass Clinic LLC Po Box 689022 Franklin TN 37068-9022 Ph: (615) 465-7230 | Wiregrass Clinic LLC 4300 W Main St Ste 405 Dothan AL 36305-1086 Ph: (334) 944-7073 |
| NPI Number | 1851063432 |
|---|---|
| Provider Enumeration Date | 10/01/2021 |
| Last Update Date | 10/01/2021 |
| Certification Date | 09/14/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851063432 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
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