Organization
WIREGRASS CLINIC LLC
Active
Other names
Dothan Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER L JACKSON (SR DIR PROV ENROLLMENT & ONBOARDING)
(615) 465-3334
Entity
Organization
Contact information
Practice address
1450 ROSS CLARK CIR STE 4, DOTHAN, AL 36301-4736
(334) 699-7900
(334) 699-7901
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
(877) 892-9815
(615) 628-6877
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003999940
—
FL
Enumeration date
06/04/2021
Last updated
09/14/2021
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