Provider Demographics
NPI:1295751626
Name:THE WOUND PRACTITIONER, LLC
Entity type:Organization
Organization Name:THE WOUND PRACTITIONER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETER
Authorized Official - Prefix:
Authorized Official - First Name:ROSELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:865-466-0768
Mailing Address - Street 1:319 BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:37763-7231
Mailing Address - Country:US
Mailing Address - Phone:865-466-0768
Mailing Address - Fax:865-717-1113
Practice Address - Street 1:2415 N GATEWAY AVE
Practice Address - Street 2:
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748-8609
Practice Address - Country:US
Practice Address - Phone:865-882-2442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000010924261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service