Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jerry Paul Wisdom III, CRNP

Individual provider Family Nurse Practitioner · NPI 1912570607

Jerry Paul Wisdom III, CRNP is a Nurse Practitioner in Dothan, Alabama. Qualified in 2021, 5 years ago. Practices with Southern Clinic PC, a 25-clinician group and accepts Medicare assignment. Licensed in Alabama.

Years since qualifying
5
Licensed in
AL
In the registry since
2021
What do these letters mean?
CRNP — Certified Registered Nurse Practitioner
The title Pennsylvania and some other states use for a nurse practitioner.

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Practice location Address checks out

1450 Ross Clark Cir Ste 400
Dothan, AL 36301-4770
Phone: (334) 305-0400
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 1-152894 (AL)

Record details

NPI number1912570607
Entity typeIndividual (Type 1)
GenderMale
Credentials CRNP
Sole proprietorNo
NPI enumeratedJuly 20, 2021
Last updated in NPPESJuly 20, 2021
Certification dateJuly 20, 2021
Mailing address1450 Ross Clark Cir Ste 400, Dothan, AL 36301-4770

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Southern Clinic Pc — 25 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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