Healthcare Provider Details

I. General information

NPI: 1972150084
Provider Name (Legal Business Name): WOUND MANAGEMENT SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2019
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 STONE CREEK BLVD STE 300
FLOWOOD MS
39232-8211
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 TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LACHELLE GRIFFIN
Title or Position: CHIEF HUMAN RESOURCE OFFICER
Credential:
Phone: 769-208-4437