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Organization
WIREGRASS CLINIC LLC
Active
Organization
WIREGRASS CLINIC LLC
Active
Parent organization
WIREGRASS CLINIC LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
WIREGRASS CLINIC LLC
Authorized official
JENNIFER L JACKSON (SR DIR PROV ENROLLMENT & ONBOARDING)
(615) 465-3334
Entity
Organization
Contact information
Practice address
4300 W MAIN ST STE 405, DOTHAN, AL 36305-1086
(334) 944-7073
(334) 944-7058
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
(615) 465-7230
(615) 628-6877
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
10/01/2021
Last updated
10/01/2021
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