Wiregrass Clinic LLC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

WIREGRASS CLINIC LLC

Practice address

4300 W Main St Ste 14
Dothan, AL 36305-1311

Phone

(334) 944-7015

Fax

(334) 944-7019

NPI assigned

Sep 30, 2021

Organization subpart

No

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 2

Addresses

Tax ID family

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

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

  • Neurology Physician
  • Dothan, AL
  • NPI 1427728393
  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": "1632960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633651200000",
    "number": "1497427199",
    "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": "615-465-7230",
            "fax_number": "615-628-6877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 W MAIN ST STE 14",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363051311",
            "telephone_number": "334-944-7015",
            "fax_number": "334-944-7019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WIREGRASS CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-30",
        "last_updated": "2021-10-08",
        "certification_date": "2021-10-08",
        "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": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• 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
• Wiregrass Homecare

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 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.