Provider Demographics
NPI:1760563159
Name:NORTH GA INSTITUTE FOR WOUND CARE, LLC
Entity Type:Organization
Organization Name:NORTH GA INSTITUTE FOR WOUND CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REENA
Authorized Official - Middle Name:A
Authorized Official - Last Name:YONKOSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-965-5862
Mailing Address - Street 1:110 SAMARITAN DR.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040
Mailing Address - Country:US
Mailing Address - Phone:678-965-5860
Mailing Address - Fax:
Practice Address - Street 1:110 SAMARITAN DR.
Practice Address - Street 2:SUITE 101
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040
Practice Address - Country:US
Practice Address - Phone:678-965-5860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0289298174400000X
0289298174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5758820001Medicare NSC