WIREGRASS WELLNESS CENTER, LLC – Psychiatry Physician, NPI 1013117167
Psychiatry Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for WIREGRASS WELLNESS CENTER, LLC
10659 NW State Road 20
Bristol, FL 323213441
Phone: (334) 673-8869
Fax: (334) 673-8851
Type: Location
4428 Lafayette St
Marianna, FL 324463405
Phone: (334) 673-8869
Fax: (334) 673-8851
Type: Location
1330 Highway 231 S
Troy, AL 360813058
Phone: (334) 673-8869
Fax: (334) 673-8851
Type: Location
153 Scouting Cir
Troy, AL 360812540
Phone: (334) 673-8869
Fax: (334) 673-8851
Type: Location
702 N Main St
Opp, AL 364671626
Phone: (334) 673-8869
Fax: (334) 673-8851
Type: Location
1200 W Maple Ave
Geneva, AL 363401642
Phone: (334) 673-8869
Fax: (334) 673-8851
Type: Location
102 Hospital Cir
Donalsonville, GA 398451100
Phone: (334) 673-8869
Fax: (334) 673-8851
Type: Location
250 Bray St
Athens, GA 306012203
Phone: (334) 673-8869
Type: Location
2880 Green St
Marianna, FL 324463357
Phone: (334) 673-8869
Type: Location
677 Church St NE
Marietta, GA 300601101
Phone: (334) 673-8869
Type: Location
Dothan Post Office, West Burdeshaw Street, Dothan, Houston County, Alabama, 36303, United States
DOTHAN, AL 363040308
Phone: (334) 673-8869
Fax: (334) 673-8851
Type: Mailing
Regency Court, Dothan, Houston County, Alabama, 36305, United States
DOTHAN, AL 363051179
Phone: (334) 673-8869
Fax: (334) 673-8851
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2017-10-02
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2023-10-31 (954 days ago).
Enrollment records
3
Earliest due date
2023-10-31
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20040910001105 | O | Clinic/Group Practice | AL | TBD |
| O20100512000498 | O | Clinic/Group Practice | FL | TBD |
| O20171002003306 | O | Clinic/Group Practice | GA | 2023-10-31 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 32321)
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