Healthcare Provider Details

I. General information

NPI: 1790693455
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

11740 COLUMBIA ST STE 1
BLAKELY GA
39823-2574
US

IV. Provider business mailing address

11740 COLUMBIA ST STE 1
BLAKELY GA
39823-2574
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