Southern Lux And Metabolic Wellness | |
3332 W Main St Ste 2 Dothan AL 36305-1019 | |
(719) 661-6033 | |
Not Available |
Full Name | Southern Lux And Metabolic Wellness |
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Speciality | Clinic/Center |
Location | 3332 W Main St Ste 2, Dothan, Alabama |
Authorized Official Name and Position | Kelley E Blake (NURSE PRACTITIONER) |
Authorized Official Contact | 7196616033 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Southern Lux And Metabolic Wellness 3332 W Main St Ste 2 Dothan AL 36305-1019 Ph: (334) 246-2577 | Southern Lux And Metabolic Wellness 3332 W Main St Ste 2 Dothan AL 36305-1019 Ph: (719) 661-6033 |
NPI Number | 1427710896 |
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Provider Enumeration Date | 10/12/2021 |
Last Update Date | 06/18/2024 |
Medicare PECOS PAC ID | 5294121935 |
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Medicare Enrollment ID | O20220406002136 |
Identifier | Type | State | Issuer |
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1427710896 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
Provider Name | Philip T Wilson |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1811256084 PECOS PAC ID: 5294972386 Enrollment ID: I20130509000066 |
Provider Name | Kelley E Blake |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1770737249 PECOS PAC ID: 4981768694 Enrollment ID: I20151201003172 |
Provider Name | Marcey Nicholas |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1972209153 PECOS PAC ID: 5092162651 Enrollment ID: I20231103002631 |
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