Healthcare Provider Details

I. General information

NPI: 1730756248
Provider Name (Legal Business Name): WIREGRASS WOUND & AMPUTATION PREVENTION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2967 ROSS CLARK CIR
DOTHAN AL
36301-1119
US

IV. Provider business mailing address

2967 ROSS CLARK CIR
DOTHAN AL
36301-1119
US

V. Phone/Fax

Practice location:
  • Phone: 334-305-2085
  • Fax:
Mailing address:
  • Phone: 334-305-2085
  • Fax: 229-723-7762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DOUG DUKE II
Title or Position: PRESIDENT
Credential: DO
Phone: 334-305-2085