=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851245807
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WIREGRASS INFECTIOUS DISEASES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2026
-----------------------------------------------------
Last Update Date | 02/26/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3124 W MAIN ST STE 3
-----------------------------------------------------
City | DOTHAN
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36305-1181
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-803-8552
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3124 W MAIN ST STE 3
-----------------------------------------------------
City | DOTHAN
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36305-1181
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-803-8552
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RAYEN-AYOUB CHAKRA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 334-803-8552
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RI0200X
-----------------------------------------------------
Taxonomy Name | Infectious Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------