Healthcare Provider Details

I. General information

NPI: 1588394100
Provider Name (Legal Business Name): WOUND MANAGEMENT SPECIALISTS TN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2022
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6584 POPLAR AVE STE 212
MEMPHIS TN
38138-3687
US

IV. Provider business mailing address

778 LIBERTY RD
FLOWOOD MS
39232-9321
US

V. Phone/Fax

Practice location:
  • Phone: 769-239-3792
  • Fax:
Mailing address:
  • Phone: 769-243-6141
  • Fax: 601-510-1665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LACHELLE GRIFFIN
Title or Position: CHIEF HUMAN RESOURCE OFFICER
Credential:
Phone: 769-208-4437