Diabetes and Wellness Clinic of the Shoals

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

DIABETES AND WELLNESS CLINIC OF THE SHOALS

Practice address

1110 E 6TH St Suite E
Muscle Shoals, AL 35661

Phone

(256) 856-4059

NPI assigned

Mar 27, 2019

Last updated

Mar 27, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Thaddeus Jason Boughton, CRNPNPI 1043553357

Title

Owner

Phone

(256) 856-4059

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Thaddeus Jason Boughton, ANP-BC

  • Adult Health Nurse Practitioner
  • Muscle Shoals, AL
  • NPI 1043553357
  Medicare reassignment NPD Authorized official
• Muhammad Nassooh Husainy, DO

  • Emergency Medicine Physician
  • Florence, AL
  • NPI 1639332273
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1553644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553644800000",
    "number": "1255892865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 CHAPPELL RD",
            "city": "MUSCLE SHOALS",
            "state": "AL",
            "postal_code": "356613650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 E 6TH ST SUITE E",
            "city": "MUSCLE SHOALS",
            "state": "AL",
            "postal_code": "35661",
            "telephone_number": "256-856-4059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIABETES AND WELLNESS CLINIC OF THE SHOALS",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-27",
        "last_updated": "2019-03-27",
        "status": "A",
        "authorized_official_last_name": "BOUGHTON",
        "authorized_official_first_name": "THADDEUS",
        "authorized_official_middle_name": "JASON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "256-856-4059",
        "authorized_official_credential": "CRNP"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marilyn Granville Davis, PH.D. , LCSW, PIP
• Stacy Davis, ANCC
• Wendy Danielle Davis, CRNP
• Desselle Surgical Clinic, LLC
• Wesley Joseph Desselle, MD
• Sloan Dickerson, DPT
• Elizabeth Boatwright Dobbs, FNP-C
• Amanda N Dodd, FNP
• Dr. J Keith Connell, DMD
• Dr. Rodney a. Tittle

• Clinic/Center in Muscle Shoals, AL
• Providers in Muscle Shoals, AL by specialty
• Clinic/Center in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.