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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51530696
BCBS
AL
Enumeration date
09/22/2006
Last updated
03/24/2008
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