Provider Demographics
NPI:1073707436
Name:SHILOH WOUND CARE PC
Entity Type:Organization
Organization Name:SHILOH WOUND CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-486-1163
Mailing Address - Street 1:3525 PIEDMONT RD NE STE 601
Mailing Address - Street 2:BLDG. 7
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1578
Mailing Address - Country:US
Mailing Address - Phone:404-842-5423
Mailing Address - Fax:404-848-1229
Practice Address - Street 1:1497 FAIR RD STE 103
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-0823
Practice Address - Country:US
Practice Address - Phone:912-486-1163
Practice Address - Fax:866-795-4593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025229208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty