Organization
WIREGRASS BEHAVIORAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS PHILLIP JOHNSON (PRESIDENT)
(334) 792-6736
Entity
Organization
Contact information
Practice address
256 HONEYSUCKLE RD STE 12, DOTHAN, AL 36305-1168
(334) 792-6736
(334) 792-6737
Mailing address
256 HONEYSUCKLE RD STE 12, DOTHAN, AL 36305-1168
(334) 792-6736
(334) 792-6737
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
08/10/2020
Last updated
08/13/2020
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