Healthcare Provider Details

I. General information

NPI: 1831423375
Provider Name (Legal Business Name): WOUND HEALING GROUP, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2009
Last Update Date: 10/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5221B CLIFF GOOKIN BLVD
TUPELO MS
38801-6781
US

IV. Provider business mailing address

5221B CLIFF GOOKIN BLVD
TUPELO MS
38801-6781
US

V. Phone/Fax

Practice location:
  • Phone: 662-620-8123
  • Fax: 662-620-8131
Mailing address:
  • Phone: 662-620-8123
  • Fax: 662-620-8131

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

VIII. Authorized Official

Name: DR. B LEWAYNE LAMBERT
Title or Position: INCORPORATOR, DIRECTOR, PRESIDENT
Credential: M.D.
Phone: 662-620-8123