Healthcare Provider Details

I. General information

NPI: 1275115362
Provider Name (Legal Business Name): WEDOWEE SPECIALTY CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 MAIN ST S STE 201
WEDOWEE AL
36278-7440
US

IV. Provider business mailing address

100 GREENWAY BLVD FL 2
CARROLLTON GA
30117-4338
US

V. Phone/Fax

Practice location:
  • Phone: 256-357-2188
  • Fax: 256-357-2023
Mailing address:
  • Phone: 770-838-8710
  • Fax: 770-812-5735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: CLINT HOFFMAN
Title or Position: SR. VP OF TMG OPERATIONS
Credential:
Phone: 770-838-8302