Healthcare Provider Details

I. General information

NPI: 1720877376
Provider Name (Legal Business Name): GULF SOUTH WOUND CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2025
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6019 WALNUT GROVE RD
MEMPHIS TN
38120-2113
US

IV. Provider business mailing address

PO BOX 6266
GULFPORT MS
39506-6266
US

V. Phone/Fax

Practice location:
  • Phone: 228-865-1330
  • Fax:
Mailing address:
  • Phone: 228-865-1330
  • Fax: 228-865-1331

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: BRETT KATHMANN
Title or Position: OWNER
Credential: MD
Phone: 228-865-1330