Provider Demographics
NPI:1003956210
Name:GLOBAL WOUND CARE
Entity Type:Organization
Organization Name:GLOBAL WOUND CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / CEO
Authorized Official - Prefix:
Authorized Official - First Name:SIVAKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:JAYABALAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD (MBA)
Authorized Official - Phone:706-284-5951
Mailing Address - Street 1:629C RONALD REAGAN DR
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-7607
Mailing Address - Country:US
Mailing Address - Phone:706-868-0319
Mailing Address - Fax:706-868-3719
Practice Address - Street 1:200 BOND ST
Practice Address - Street 2:SUITE 109
Practice Address - City:ROYSTON
Practice Address - State:GA
Practice Address - Zip Code:30662-4137
Practice Address - Country:US
Practice Address - Phone:706-245-4040
Practice Address - Fax:706-245-4070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA028075208D00000X
GAPOD000686213E00000X
GAPOD000824213E00000X
GAPOD001075213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00521353BMedicaid
GA00521353BMedicaid