Healthcare Provider Details

I. General information

NPI: 1770496556
Provider Name (Legal Business Name): PREMIER INDEPENDENT CARE OF TUSCALOOSA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 W TROY ST STE B
DOTHAN AL
36303-4455
US

IV. Provider business mailing address

212 W TROY ST STE B
DOTHAN AL
36303-4455
US

V. Phone/Fax

Practice location:
  • Phone: 659-258-2423
  • Fax:
Mailing address:
  • Phone: 659-258-2423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: RENNOTTA WIGGINS
Title or Position: OWNER
Credential:
Phone: 205-886-4933