Healthcare Provider Details

I. General information

NPI: 1104702729
Provider Name (Legal Business Name): PREMIER WOUND CARE OF TENNESSEE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 W MORRIS BLVD STE A200
MORRISTOWN TN
37813-3880
US

IV. Provider business mailing address

1326 PAPERMILL POINTE WAY
KNOXVILLE TN
37909-1903
US

V. Phone/Fax

Practice location:
  • Phone: 423-522-8700
  • Fax: 423-522-8701
Mailing address:
  • Phone: 423-522-8700
  • Fax: 423-522-8701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LEONARD HALES
Title or Position: CREDENTIALING
Credential:
Phone: 615-403-4546