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NPI Code Detail

MEDICARE: WILLINGHAM MEDICAL CLINIC, RHC, PLLC

MEDICARE: WILLINGHAM MEDICAL CLINIC, RHC, PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP2300XPrimary Care Nurse Practitioner

General Provider Information

NPI Number : 1386210771
Entity Type Code : Organization
Provider Name (Legal Business Name) : WILLINGHAM MEDICAL CLINIC, RHC, PLLC
Provider Business Mailing Address
First Line : 212 W TROY ST STE B
Second Line :
City : DOTHAN
State : AL
Zip : 36303-4455
Country : US
Telephone Number : 334-437-1141
Fax Number :
Provider Business Practice Location Address
First Line : 212 W TROY ST STE B
Second Line :
City : DOTHAN
State : AL
Zip : 36303-4455
Country : US
Telephone Number : 334-437-1411
Fax Number :
Authorized Official
Title or Position : FAMILY NURSE PRACTITIONER/OWNER
Name : MR. DEMETRIUS STEELE
Credential : DEMETRIUS STEELE
Telephone Number : 334-437-1141
Provider Enumeration Date : 05/27/2021
Last Update Date : 05/27/2021

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Directions to “WILLINGHAM MEDICAL CLINIC, RHC, PLLC ” Practice Location

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