Basic Information
| Provider Information | |||||||||
| NPI: | 1902198344 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WOUND CARE SOLUTIONS INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3000 KEENAN RD | ||||||||
| Address2: | |||||||||
| City: | COLLEGE PARK | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303494644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709941078 | ||||||||
| FaxNumber: | 7709949251 | ||||||||
| Practice Location | |||||||||
| Address1: | 1170 CLEVELAND AVE | ||||||||
| Address2: | |||||||||
| City: | EAST POINT | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303443615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4044661170 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2011 | ||||||||
| LastUpdateDate: | 05/04/2011 | ||||||||
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| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | SANDRA | ||||||||
| AuthorizedOfficialMiddleName: | JEAN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/ PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 7709941078 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | NP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | RN056087 | GA | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.