Provider Demographics
NPI:1992004923
Name:GEORGIA WOUND PHYSICIANS, LLC
Entity Type:Organization
Organization Name:GEORGIA WOUND PHYSICIANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:W
Authorized Official - Last Name:JONES
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:706-346-6328
Mailing Address - Street 1:7 HUNTINGTON RD SW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-6660
Mailing Address - Country:US
Mailing Address - Phone:706-346-6328
Mailing Address - Fax:
Practice Address - Street 1:2304 SHORTER AVE NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1944
Practice Address - Country:US
Practice Address - Phone:706-346-6328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty