Healthcare Provider Details

I. General information

NPI: 1003720053
Provider Name (Legal Business Name): WOUND MANAGEMENT AND VASCULAR SURGERY CENTER AT STONE CREEK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 STONE CREEK BLVD STE 800
FLOWOOD MS
39232-8205
US

IV. Provider business mailing address

778 LIBERTY RD
FLOWOOD MS
39232-9321
US

V. Phone/Fax

Practice location:
  • Phone: 769-243-6141
  • Fax: 601-510-1665
Mailing address:
  • Phone: 769-243-6141
  • Fax: 601-510-1665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: LACHELLE GRIFFIN
Title or Position: CHRO
Credential:
Phone: 769-208-4437