Healthcare Provider Details

I. General information

NPI: 1740152511
Provider Name (Legal Business Name): PERRY HOME WOUND CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2025
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 RUSTY PLOW LN
PERRY GA
31069-9870
US

IV. Provider business mailing address

211 RUSTY PLOW LN
PERRY GA
31069-9870
US

V. Phone/Fax

Practice location:
  • Phone: 478-442-9926
  • Fax:
Mailing address:
  • Phone: 478-310-4446
  • Fax: 478-721-9473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JEPTHE NKWANMEN
Title or Position: MANAGING MEMBER
Credential: RN
Phone: 478-442-9926