Healthcare Provider Details

I. General information

NPI: 1689612640
Provider Name (Legal Business Name): HYPERBARIC WOUND SPECIALISTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 02/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160A W TENNESSEE AVE THE WOUND TREATMENT CENTER
OAK RIDGE TN
37830-6501
US

IV. Provider business mailing address

969 OAK RIDGE TPKE PMB 222
OAK RIDGE TN
37830-8832
US

V. Phone/Fax

Practice location:
  • Phone: 865-835-5374
  • Fax:
Mailing address:
  • Phone: 865-482-4028
  • Fax: 865-481-3257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MS. DEANNA H LOWE
Title or Position: SECRETARY
Credential:
Phone: 865-482-4028