Healthcare Provider Details

I. General information

NPI: 1467118448
Provider Name (Legal Business Name): GULF COAST WOUND ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2021
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5427 GEX RD
DIAMONDHEAD MS
39525-3208
US

IV. Provider business mailing address

PO BOX 6705
GULFPORT MS
39506-6705
US

V. Phone/Fax

Practice location:
  • Phone: 228-255-4832
  • Fax:
Mailing address:
  • Phone: 228-865-1330
  • Fax: 228-865-1331

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: DR. NATHAN GILL
Title or Position: PHYSICIAN
Credential: DO
Phone: 228-236-4066