Healthcare Provider Details

I. General information

NPI: 1598684599
Provider Name (Legal Business Name): VERISWOUND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 MACY DR
ROSWELL GA
30076-6349
US

IV. Provider business mailing address

1600 MACY DR
ROSWELL GA
30076-6349
US

V. Phone/Fax

Practice location:
  • Phone: 678-431-7386
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: TYE MCCLELLAN
Title or Position: BILLING MANAGER
Credential:
Phone: 404-933-8509