Provider Demographics
NPI:1003191933
Name:WOMEN'S WELLNESS CENTER OF DOTHAN, LLC
Entity Type:Organization
Organization Name:WOMEN'S WELLNESS CENTER OF DOTHAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRENACE
Authorized Official - Middle Name:I
Authorized Official - Last Name:DUBREUIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-699-8444
Mailing Address - Street 1:104 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-6902
Mailing Address - Country:US
Mailing Address - Phone:334-699-8444
Mailing Address - Fax:334-836-0059
Practice Address - Street 1:104 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-6902
Practice Address - Country:US
Practice Address - Phone:334-699-8444
Practice Address - Fax:334-836-0059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22347207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty