Provider Demographics
NPI:1679840375
Name:PROFESSIONAL RESOURCE MANAGEMENT OF WIREGRASS, LLC
Entity Type:Organization
Organization Name:PROFESSIONAL RESOURCE MANAGEMENT OF WIREGRASS, LLC
Other - Org Name:OZARK SPECIALTY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNERS
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAKIR
Authorized Official - Middle Name:R
Authorized Official - Last Name:MEGHANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-712-1170
Mailing Address - Street 1:1841 HONEYSUCKLE RD
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-4269
Mailing Address - Country:US
Mailing Address - Phone:334-712-1170
Mailing Address - Fax:334-712-1106
Practice Address - Street 1:218 HOSPITAL AVE STE C
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AL
Practice Address - Zip Code:36360-2072
Practice Address - Country:US
Practice Address - Phone:334-712-1170
Practice Address - Fax:334-712-1106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-23
Last Update Date:2011-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty