Healthcare Provider Details

I. General information

NPI: 1962292409
Provider Name (Legal Business Name): MOBILE WOUND CARE SOLUTIONS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 WESTGATE CIR
BRENTWOOD TN
37027-8019
US

IV. Provider business mailing address

319 VANN DR STE E #60
JACKSON TN
38305-6032
US

V. Phone/Fax

Practice location:
  • Phone: 731-571-0902
  • Fax:
Mailing address:
  • Phone: 731-571-0902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIAN BALLINGER
Title or Position: OWNER
Credential:
Phone: 731-571-0902