Healthcare Provider Details

I. General information

NPI: 1376363291
Provider Name (Legal Business Name): AMENITY WOUND CARE SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 CHAMBLEE TUCKER RD BLDG 14
ATLANTA GA
30341-4100
US

IV. Provider business mailing address

2900 CHAMBLEE TUCKER RD BLDG 14
ATLANTA GA
30341-4100
US

V. Phone/Fax

Practice location:
  • Phone: 678-365-6358
  • Fax: 855-552-3776
Mailing address:
  • Phone: 678-365-6358
  • Fax: 855-552-3776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: LISA MERKOW
Title or Position: BUSINESS MANAGER
Credential:
Phone: 727-800-9958