Provider Demographics
NPI:1336014687
Name:PENTUS HEALTH WOUNDCARE OF GEORGIA
Entity type:Organization
Organization Name:PENTUS HEALTH WOUNDCARE OF GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANGER
Authorized Official - Prefix:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-480-5263
Mailing Address - Street 1:11680 GREAT OAKS WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-2458
Mailing Address - Country:US
Mailing Address - Phone:855-539-6863
Mailing Address - Fax:
Practice Address - Street 1:11680 GREAT OAKS WAY STE 100
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-2458
Practice Address - Country:US
Practice Address - Phone:855-539-6863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-07
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty