Healthcare Provider Details

I. General information

NPI: 1407724164
Provider Name (Legal Business Name): INSIDE OUT ADVANCED WOUND CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2025
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BALTIMORE PL NW STE 400
ATLANTA GA
30308-2117
US

IV. Provider business mailing address

1 BALTIMORE PL NW STE 400
ATLANTA GA
30308-2117
US

V. Phone/Fax

Practice location:
  • Phone: 404-680-2653
  • Fax:
Mailing address:
  • Phone: 404-680-2653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MIRANDA BOWEN
Title or Position: CREDENTIALING
Credential:
Phone: 615-504-1984