Healthcare Provider Details

I. General information

NPI: 1841814928
Provider Name (Legal Business Name): WOUNDS ON WHEELS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 VALLEY VIEW TRL
DALLAS GA
30132-5561
US

IV. Provider business mailing address

210 VALLEY VIEW TRL
DALLAS GA
30132-5561
US

V. Phone/Fax

Practice location:
  • Phone: 678-463-3677
  • Fax:
Mailing address:
  • Phone: 678-463-3677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State

VIII. Authorized Official

Name: MS. LORIA JEAN FLANAGAN
Title or Position: LPN
Credential: CERTIFIED WOUND CARE
Phone: 678-463-3677