Healthcare Provider Details

I. General information

NPI: 1487519625
Provider Name (Legal Business Name): RENU WOUND CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 MONTGOMERY DR
STOCKBRIDGE GA
30281-2839
US

IV. Provider business mailing address

261 MONTGOMERY DR
STOCKBRIDGE GA
30281-2839
US

V. Phone/Fax

Practice location:
  • Phone: 470-482-9217
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER STAFFORD
Title or Position: OWNER
Credential:
Phone: 847-252-1258