Organization
WIREGRASS CLINIC LLC
Active
Parent organization
WIREGRASS CLINIC LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
WIREGRASS CLINIC LLC
Authorized official
JENNIFER L JACKSON (SR DIR PROV ENROLLMENT & ONBOARDING)
(615) 465-3334
Entity
Organization
Contact information
Practice address
348 HEALTHWEST DR, DOTHAN, AL 36303-1907
(334) 944-7006
(334) 305-0076
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
(877) 892-9815
(615) 628-6877
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
—
Other
Enumeration date
09/14/2021
Last updated
09/14/2021
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