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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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