Provider Demographics
NPI:1982941936
Name:NATIONAL TELEWOUND CARE
Entity Type:Organization
Organization Name:NATIONAL TELEWOUND CARE
Other - Org Name:NORTH CAROLINA TELEWOUND CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-371-2204
Mailing Address - Street 1:374 OSPREY PT
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-6163
Mailing Address - Country:US
Mailing Address - Phone:678-371-2204
Mailing Address - Fax:877-210-5143
Practice Address - Street 1:2015 GUM BRANCH RD
Practice Address - Street 2:624
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-4583
Practice Address - Country:US
Practice Address - Phone:678-371-2204
Practice Address - Fax:877-210-5143
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATIONAL TELEWOUND CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty