NPIMap

Organization Active NPI

Wiregrass Clinic LLC

  • Family Medicine Physician
  • Dothan, AL
National Provider Identifier
1851063432
Registry record updated Oct 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
WIREGRASS CLINIC LLC
Practice address
4300 W Main St Ste 405
Dothan, AL 36305-1086
Phone
(334) 944-7073
Fax
(334) 944-7058
NPI assigned
Oct 1, 2021
Organization subpart
Yes
Parent organization
WIREGRASS CLINIC LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 1, 2021

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

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

4300 W Main St Ste 405
Dothan, AL 36305-1086

Mailing address

PO Box 689022
Franklin, TN 37068-9022
Phone (615) 465-7230

National Provider Directory

National Provider Directory
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.

Locations

4300 W Main St
Ste 405
Dothan, AL 36305
Phone (334) 944-7073

NPI Registry JSON

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

{
    "created_epoch": "1633046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633046400000",
    "number": "1851063432",
    "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 405",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363051086",
            "telephone_number": "334-944-7073",
            "fax_number": "334-944-7058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WIREGRASS CLINIC LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WIREGRASS CLINIC LLC",
        "enumeration_date": "2021-10-01",
        "last_updated": "2021-10-01",
        "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": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dothan, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 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.