Provider Demographics
NPI:1205370632
Name:WOUND CARE & HYPERBARIC CENTER
Entity Type:Organization
Organization Name:WOUND CARE & HYPERBARIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLIAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-447-0966
Mailing Address - Street 1:1227 ROCKBRIDGE RD
Mailing Address - Street 2:SUITE 208-82
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-3064
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6000 HILLANDALE DR
Practice Address - Street 2:SUITE 150
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-4840
Practice Address - Country:US
Practice Address - Phone:770-778-7009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-03
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty