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General NPI Number Information
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NPI Number | 1013117167
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Entity Type | Organization
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Legal Business Name | WIREGRASS WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 07/18/2007
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Last Update Date | 04/04/2025
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Provider Practice Location Address
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Address Line | 201 REGENCY CT
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City | DOTHAN
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State | AL
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Zip | 36305-1179
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Country | US
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Telephone | 334-673-8869
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Fax | 334-673-8851
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Provider Business Mailing Address
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Address Line | PO BOX 8308
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City | DOTHAN
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State | AL
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Zip | 36304-0308
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Country | US
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Telephone | 334-673-8869
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Fax | 334-673-8851
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Authorized Official
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Title or Position | CFO
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Name | MR. DAVID KENTON STRUNK
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Credential |
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Telephone | 423-215-0627
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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