Healthcare Provider Details

I. General information

NPI: 1235404377
Provider Name (Legal Business Name): DELTA WOUND CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2012
Last Update Date: 03/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 E SUNFLOWER RD SUITE 102
CLEVELAND MS
38732-2830
US

IV. Provider business mailing address

494 HILLCREST CIR
CLEVELAND MS
38732-2008
US

V. Phone/Fax

Practice location:
  • Phone: 662-545-4443
  • Fax: 662-545-4351
Mailing address:
  • Phone: 662-721-8877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: PATRICK E SEWELL
Title or Position: MANAGING MEMBER/OWNER
Credential: MD
Phone: 662-721-8877