Healthcare Provider Details

I. General information

NPI: 1629625041
Provider Name (Legal Business Name): MARTIN WOUND CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2019
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11491 US HIGHWAY 431
ALBERTVILLE AL
35950-0136
US

IV. Provider business mailing address

5903 SPRING CIR
GUNTERSVILLE AL
35976-2811
US

V. Phone/Fax

Practice location:
  • Phone: 256-505-6826
  • Fax: 256-571-2862
Mailing address:
  • Phone: 256-505-6826
  • Fax: 256-571-2862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: SYDNEY JONES
Title or Position: BILLING DIRECTOR
Credential: MACC
Phone: 256-505-6826