| Wiregrass Behavioral Group Llc | |
|
256 Honeysuckle Rd Ste 12 Dothan AL 36305-1168 | |
| (334) 792-6736 | |
| (334) 792-6737 |
| Full Name | Wiregrass Behavioral Group Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 256 Honeysuckle Rd Ste 12, Dothan, Alabama |
| Authorized Official Name and Position | Phillip Johnson (PRESIDENT) |
| Authorized Official Contact | 3347926736 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wiregrass Behavioral Group Llc 256 Honeysuckle Rd Ste 12 Dothan AL 36305-1168 Ph: (334) 792-6736 | Wiregrass Behavioral Group Llc 256 Honeysuckle Rd Ste 12 Dothan AL 36305-1168 Ph: (334) 792-6736 |
| NPI Number | 1821609389 |
|---|---|
| Provider Enumeration Date | 08/10/2020 |
| Last Update Date | 08/13/2020 |
| Medicare PECOS PAC ID | 6103244504 |
|---|---|
| Medicare Enrollment ID | O20200917000368 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821609389 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Jimmie S Guyton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932664653 PECOS PAC ID: 3870833429 Enrollment ID: I20190319001948 |
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