Organization
WIREGRASS WELLNESS CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID KENTON STRUNK (CFO)
(423) 215-0627
Entity
Organization
Contact information
Practice address
201 REGENCY CT, DOTHAN, AL 36305-1179
(334) 673-8869
(334) 673-8851
Mailing address
PO BOX 8308, DOTHAN, AL 36304-0308
(334) 673-8869
(334) 673-8851
Taxonomy
Speciality
Code
Description
License number
State
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
2084P0805X
Geriatric Psychiatry Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009966175
—
AL
05
—
010838800
—
FL
01
—
0348462
CIGNA
AL
01
—
1013117167
NPI
—
01
—
1080690
BEACON
FL
01
—
1104332527
NPI
—
01
—
11498415
CAQH
—
01
—
1811983596
NPI
—
05
—
188102
—
AL
01
—
19C1R
NEW DIRECTIONS
AL
05
—
229432
—
AL
05
—
407098142C
—
GA
01
—
410459675
TRICARE
AL
01
—
50198
FLORIDA BLUE
FL
01
—
51521565
BCBS
AL
01
—
523314
VALUE OPTIONS
AL
05
—
529920780
—
AL
01
—
601701400
DOL
AL
01
—
774089000
MAGELLAN
AL
05
—
914438200
—
FL
01
—
Q6YNL
FLORIDA BCBS
FL
Enumeration date
07/18/2007
Last updated
04/04/2025
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