Healthcare Provider Details

I. General information

NPI: 1588495675
Provider Name (Legal Business Name): WOUND CARE MEDICAL GROUP TENNESSEE PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 DEER PARK DR
NASHVILLE TN
37205-3319
US

IV. Provider business mailing address

8161 HIGHWAY 100 # 264
NASHVILLE TN
37221-4213
US

V. Phone/Fax

Practice location:
  • Phone: 737-703-8191
  • Fax:
Mailing address:
  • Phone: 737-703-8191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DARRINGTON PHILLIPS ALTENBERN
Title or Position: SOLE OWNER, AUTH OFFICIAL
Credential: MD
Phone: 615-405-5235