Provider Demographics
NPI:1245508985
Name:PROFESSIONAL RESOURCE MANAGEMENT OF WIREGRASS, LLC
Entity type:Organization
Organization Name:PROFESSIONAL RESOURCE MANAGEMENT OF WIREGRASS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
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 1:218 HOSPITAL AVE STE C
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AL
Mailing Address - Zip Code:36360-2072
Mailing Address - Country:US
Mailing Address - Phone:334-774-5005
Mailing Address - Fax:334-774-5007
Practice Address - Street 1:1970 ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AL
Practice Address - Zip Code:36360
Practice Address - Country:US
Practice Address - Phone:334-712-1170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-08
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty