Healthcare Provider Details

I. General information

NPI: 1801705132
Provider Name (Legal Business Name): WIREWALL HEALTHCARE DISTRIBUTION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 S OATES ST STE 8
DOTHAN AL
36301-0600
US

IV. Provider business mailing address

3600 S OATES ST STE 8
DOTHAN AL
36301-0600
US

V. Phone/Fax

Practice location:
  • Phone: 334-435-7545
  • Fax:
Mailing address:
  • Phone: 334-435-7545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. RADCLIFFE REID GREEN
Title or Position: OWNER OPERATOR
Credential:
Phone: 334-435-7545