Healthcare Provider Details

I. General information

NPI: 1144087446
Provider Name (Legal Business Name): CHRONIC WOUND CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 EASTBROOK BND STE 218
PEACHTREE CITY GA
30269-1546
US

IV. Provider business mailing address

3604 HINTOCKS CIR
CARMEL IN
46032-9148
US

V. Phone/Fax

Practice location:
  • Phone: 678-967-5599
  • Fax: 678-603-9843
Mailing address:
  • Phone: 678-967-5599
  • Fax: 678-603-9843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PAUL MILLER
Title or Position: CEO
Credential:
Phone: 678-699-4977