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General NPI Number Information
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NPI Number | 1144905985
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Entity Type | Organization
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Legal Business Name | ABIDE HEALTH & WELLNESS LLC
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Dates
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Enumeration Date | 06/20/2023
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Last Update Date | 12/06/2023
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Provider Practice Location Address
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Address Line | 3113 WESLEY WAY STE 2
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City | DOTHAN
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State | AL
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Zip | 36305-2004
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Country | US
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Telephone | 334-203-4145
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Fax | 334-245-0335
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Provider Business Mailing Address
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Address Line | 3113 WESLEY WAY STE 2
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City | DOTHAN
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State | AL
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Zip | 36305-2004
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Country | US
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Telephone | 334-203-4145
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Fax | 334-245-0335
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | JUANITA TITRUD HEERSINK
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Credential | MD
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Telephone | 205-807-6482
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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