| |
105 S Woodburn Dr Ste 2 Dothan AL 36305-1109 | |
(334) 790-9872 | |
Not Available |
Full Name | |
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Speciality | Family Medicine |
Location | 105 S Woodburn Dr Ste 2, Dothan, Alabama |
Authorized Official Name and Position | Philip Wilson (OWNER) |
Authorized Official Contact | 3347909872 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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107 Christen Ln Dothan AL 36305-3140 Ph: (334) 791-2406 | 105 S Woodburn Dr Ste 2 Dothan AL 36305-1109 Ph: (334) 790-9872 |
NPI Number | 1881437762 |
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Provider Enumeration Date | 06/17/2024 |
Last Update Date | 01/28/2025 |
Medicare PECOS PAC ID | 3870032725 |
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Medicare Enrollment ID | O20240823001346 |
Identifier | Type | State | Issuer |
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1881437762 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (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 |
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