Individual
MR. JACOB TYLER WAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RRNA
Contact information
Practice address
4370 W MAIN ST, DOTHAN, AL 36305-4000
(334) 793-5000
Mailing address
4370 W MAIN ST, DOTHAN, AL 36305-4000
(334) 793-5000
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
1-178236
AL
Other
Enumeration date
10/14/2025
Last updated
10/14/2025
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