Provider Demographics
NPI:1932078615
Name:NEW SKIN MOBILE WOUND CARE LLC
Entity type:Organization
Organization Name:NEW SKIN MOBILE WOUND CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:LANDRUM
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:678-542-7256
Mailing Address - Street 1:3786 ATLANTA RD SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-5934
Mailing Address - Country:US
Mailing Address - Phone:678-542-7256
Mailing Address - Fax:
Practice Address - Street 1:3786 ATLANTA RD SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-5934
Practice Address - Country:US
Practice Address - Phone:678-542-7256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-01
Last Update Date:2025-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty