Provider Demographics
NPI:1336479849
Name:WOUND CARE CLINIC ESU, INC
Entity Type:Organization
Organization Name:WOUND CARE CLINIC ESU, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:KREISSLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-998-0040
Mailing Address - Street 1:1000 TOWNE CENTER BLVD
Mailing Address - Street 2:SUITE 705
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-4052
Mailing Address - Country:US
Mailing Address - Phone:912-998-0040
Mailing Address - Fax:912-998-0041
Practice Address - Street 1:1000 TOWNE CENTER BLVD
Practice Address - Street 2:SUITE 705
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4052
Practice Address - Country:US
Practice Address - Phone:912-998-0040
Practice Address - Fax:912-998-0041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3118839999261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty