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Organization
WIREGRASS FAMILY PRACTICE OF DOTHAN PC
Active
Organization
WIREGRASS FAMILY PRACTICE OF DOTHAN PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MIMS HACKETT ADMINISTRATOR (ADMINISTRATOR)
(334) 699-8585
Entity
Organization
Contact information
Practice address
1836 W MAIN ST, DOTHAN, AL 36301-1320
(334) 699-8585
(334) 699-8587
Mailing address
1836 W MAIN ST, DOTHAN, AL 36301-1320
(334) 699-8585
(334) 699-8587
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
09/22/2006
Last updated
03/24/2008
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