Healthcare Provider Details

I. General information

NPI: 1639033780
Provider Name (Legal Business Name): SC WOUND SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6020 JIBE CT
AWENDAW SC
29429-6320
US

IV. Provider business mailing address

6020 JIBE CT
AWENDAW SC
29429-6320
US

V. Phone/Fax

Practice location:
  • Phone: 843-697-5727
  • Fax:
Mailing address:
  • Phone: 843-697-5727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: AMANDA LARSON
Title or Position: AUTHORIZED OFFICIAL
Credential: MD/CEO
Phone: 843-697-5727