Wiregrass Clinic LLC

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

Legal business name

WIREGRASS CLINIC LLC

Practice address

348 Healthwest Dr
Dothan, AL 36303-1907

Phone

(334) 944-7006

Fax

(334) 305-0076

NPI assigned

Sep 14, 2021

Organization subpart

Yes

Parent organization

WIREGRASS CLINIC LLCAs reported in NPPES

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

Authorized official

Name

Jennifer L Jackson

Title

Sr Dir Prov Enrollment & Onboarding

Phone

(615) 465-3334

Specialties & licenses 1

Addresses

Tax ID family

Gadsden Regional Physician4 organizations share this tax ID, including this one

Part of

Gadsden Regional Physician

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

• Wiregrass Clinic LLC

  • Surgery Physician
  • Dothan, AL
  • NPI 1346817772
  NPD tax ID
• Wiregrass Clinic LLC

  • Surgery Physician
  • Dothan, AL
  • NPI 1497427199
  NPD tax ID
• Wiregrass Clinic LLC

  • Family Medicine Physician
  • Dothan, AL
  • NPI 1851063432
  NPD tax ID

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

{
    "created_epoch": "1631577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631577600000",
    "number": "1427728393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 689022",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370689022",
            "telephone_number": "877-892-9815",
            "fax_number": "615-628-6877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "348 HEALTHWEST DR",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363031907",
            "telephone_number": "334-944-7006",
            "fax_number": "334-305-0076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WIREGRASS CLINIC LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WIREGRASS CLINIC LLC",
        "enumeration_date": "2021-09-14",
        "last_updated": "2021-09-14",
        "certification_date": "2021-09-14",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SR DIR PROV ENROLLMENT & ONBOARDING",
        "authorized_official_telephone_number": "615-465-3334"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taylor Wilson
• Tericka Wilson
• Samuel Pope Winegar, DO
• Wiregrass Behavioral Group LLC
• Wiregrass Clinic LLC
• Wiregrass Clinic LLC
• Wiregrass Clinic LLC
• Wiregrass Clinic LLC
• Wiregrass Counseling Services
• Wiregrass Family Practice of Dothan PC

• Neurology Physician in Dothan, AL
• Providers in Dothan, AL by specialty
• Neurology Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.