Healthcare Provider Details

I. General information

NPI: 1972836070
Provider Name (Legal Business Name): WOUND HEALING CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 10/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4107 HIGH ROCK RD
GIBSONVILLE NC
27249-9747
US

IV. Provider business mailing address

4107 HIGH ROCK RD
GIBSONVILLE NC
27249-9747
US

V. Phone/Fax

Practice location:
  • Phone: 336-706-5190
  • Fax:
Mailing address:
  • Phone: 336-706-5190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number22315
License Number StateNC

VIII. Authorized Official

Name: DR. HAROLD A NICHOLS
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 336-706-5190