Healthcare Provider Details

I. General information

NPI: 1003191933
Provider Name (Legal Business Name): WOMEN'S WELLNESS CENTER OF DOTHAN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2011
Last Update Date: 10/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 MEDICAL DR
DOTHAN AL
36303-6902
US

IV. Provider business mailing address

104 MEDICAL DR
DOTHAN AL
36303-6902
US

V. Phone/Fax

Practice location:
  • Phone: 334-699-8444
  • Fax: 334-836-0059
Mailing address:
  • Phone: 334-699-8444
  • Fax: 334-836-0059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number22347
License Number StateAL

VIII. Authorized Official

Name: DR. TRENACE I. DUBREUIL
Title or Position: OWNER
Credential: M.D.
Phone: 334-699-8444