MEDICARE: MOBILE WOUNDDR PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207N00000X	Dermatology Physician
2	207R00000X	Internal Medicine Physician
3	213E00000X	Podiatrist

General Provider Information

NPI Number	:	1174251078
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBILE WOUNDDR PLLC

Provider Business Mailing Address
First Line	:	955 MINNESOTA AVE
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32789-4926
Country	:	US
Telephone Number	:	248-915-8986
Fax Number	:

Provider Business Practice Location Address
First Line	:	955 MINNESOTA AVE
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32789-4926
Country	:	US
Telephone Number	:	248-915-8986
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. CHANNA WILLIAMS
Credential	:	DPM
Telephone Number	:	248-915-8986

Provider Enumeration Date	:	08/10/2022
Last Update Date	:	04/12/2024

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