Organization
PROFESSIONAL RESOURCE MANAGEMENT OF WIREGRASS, LLC
Active
Other names
SOUTHEAST PSYCHIATRIC SERVICES
Organization subpart
No
Provider details
NPI number
Authorized official
NANCY A GILLEY (AUTHORIZED OFFICIAL)
(334) 712-1170
Entity
Organization
Contact information
Practice address
2812 HARTFORD HWY STE 1, DOTHAN, AL 36305-4927
(334) 712-1170
(334) 460-8391
Mailing address
2812 HARTFORD HWY STE 1, DOTHAN, AL 36305-4927
(334) 712-1170
(334) 460-8391
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
134225
—
AL
Enumeration date
11/01/2011
Last updated
12/22/2020
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