Provider Demographics
NPI:1477974186
Name:ALLIANT WOUND CARE
Entity Type:Organization
Organization Name:ALLIANT WOUND CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-314-0924
Mailing Address - Street 1:70 MANSELL CT
Mailing Address - Street 2:SUITE 100, PMB 18
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-1523
Mailing Address - Country:US
Mailing Address - Phone:678-278-9217
Mailing Address - Fax:
Practice Address - Street 1:70 MANSELL CT
Practice Address - Street 2:SUITE 100, PMB 18
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1523
Practice Address - Country:US
Practice Address - Phone:678-278-9217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-23
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA64699OtherLICENSE NUMBER