Healthcare Provider Details

I. General information

NPI: 1427710896
Provider Name (Legal Business Name): B&W MEDICAL SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2021
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3332 W MAIN ST STE 2
DOTHAN AL
36305-1019
US

IV. Provider business mailing address

3332 W MAIN ST STE 2
DOTHAN AL
36305-1019
US

V. Phone/Fax

Practice location:
  • Phone: 719-661-6033
  • Fax:
Mailing address:
  • Phone: 334-246-2577
  • Fax: 949-561-5764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KELLEY E BLAKE
Title or Position: NURSE PRACTITIONER
Credential: NP-C
Phone: 719-661-6033