Healthcare Provider Details

I. General information

NPI: 1891603551
Provider Name (Legal Business Name): WIREGRASS WOUND & AMPUTATION PREVENTION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
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:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: J. DOUGLAS DUKE II
Title or Position: OWNER
Credential:
Phone: 334-334-3085