Organization
PROFESSIONAL RESOURCE MANAGMENT OF WIREGRASS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NANCY A GILLEY (AUTHORIZED OFFICIAL)
(334) 712-1170
Entity
Organization
Contact information
Practice address
1970 ANDREWS AVE, OZARK, AL 36360-3726
(334) 774-1555
Mailing address
2812 HARTFORD HWY STE 1, DOTHAN, AL 36305-4927
(334) 712-1170
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
529923390
—
AL
01
—
K365
MEDICARE GROUP
AL
Enumeration date
11/30/2006
Last updated
12/22/2020
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