Provider Demographics
NPI:1730756248
Name:WIREGRASS WOUND & AMPUTATION PREVENTION CENTER, LLC
Entity type:Organization
Organization Name:WIREGRASS WOUND & AMPUTATION PREVENTION CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:DUKE
Authorized Official - Suffix:II
Authorized Official - Credentials:DO
Authorized Official - Phone:334-305-2085
Mailing Address - Street 1:2967 ROSS CLARK CIR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-1119
Mailing Address - Country:US
Mailing Address - Phone:334-305-2085
Mailing Address - Fax:
Practice Address - Street 1:2967 ROSS CLARK CIR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-1119
Practice Address - Country:US
Practice Address - Phone:334-305-2085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-04
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty