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General NPI Number Information
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NPI Number | 1033495221
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL RESOURCE MANAGEMENT OF WIREGRASS, LLC
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Dates
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Enumeration Date | 11/01/2011
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Last Update Date | 12/22/2020
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Provider Practice Location Address
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Address Line | 2812 HARTFORD HWY STE 1
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City | DOTHAN
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State | AL
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Zip | 36305-4927
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Country | US
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Telephone | 334-712-1170
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Fax | 334-460-8391
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Provider Business Mailing Address
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Address Line | 2812 HARTFORD HWY STE 1
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City | DOTHAN
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State | AL
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Zip | 36305-4927
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Country | US
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Telephone | 334-712-1170
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Fax | 334-460-8391
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | NANCY A GILLEY
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Credential |
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Telephone | 334-712-1170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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