MEDICARE: SHILOH WOUND CARE PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	025229	GA

General Provider Information

NPI Number	:	1073707436
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHILOH WOUND CARE PC

Provider Business Mailing Address
First Line	:	3525 PIEDMONT RD NE STE 601
Second Line	:	BLDG. 7
City	:	ATLANTA
State	:	GA
Zip	:	30305-1578
Country	:	US
Telephone Number	:	404-842-5423
Fax Number	:	404-848-1229

Provider Business Practice Location Address
First Line	:	1497 FAIR RD STE 103
Second Line	:
City	:	STATESBORO
State	:	GA
Zip	:	30458-0823
Country	:	US
Telephone Number	:	912-486-1163
Fax Number	:	866-795-4593

Authorized Official
Title or Position	:	PRES
Name	:	DR. JOHN E MARTIN
Credential	:	MD
Telephone Number	:	912-486-1163

Provider Enumeration Date	:	08/29/2007
Last Update Date	:	09/01/2010

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