Healthcare Provider Details

I. General information

NPI: 1245508985
Provider Name (Legal Business Name): PROFESSIONAL RESOURCE MANAGEMENT OF WIREGRASS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2011
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 ANDREWS AVE
OZARK AL
36360
US

IV. Provider business mailing address

218 HOSPITAL AVE STE C
OZARK AL
36360-2072
US

V. Phone/Fax

Practice location:
  • Phone: 334-712-1170
  • Fax:
Mailing address:
  • Phone: 334-774-5005
  • Fax: 334-774-5007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHAKIR R MEGHANI
Title or Position: OWNER
Credential: MD
Phone: 334-712-1170