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General NPI Number Information
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NPI Number | 1003956210
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Entity Type | Organization
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Legal Business Name | GLOBAL WOUND CARE
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 09/06/2013
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Provider Practice Location Address
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Address Line | 200 BOND ST SUITE 109
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City | ROYSTON
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State | GA
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Zip | 30662-4137
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Country | US
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Telephone | 706-245-4040
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Fax | 706-245-4070
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Provider Business Mailing Address
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Address Line | 629C RONALD REAGAN DR
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City | EVANS
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State | GA
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Zip | 30809-7607
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Country | US
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Telephone | 706-868-0319
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Fax | 706-868-3719
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Authorized Official
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Title or Position | OWNER / CEO
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Name | SIVAKUMAR JAYABALAN
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Credential | PHD. (MBA)
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Telephone | 706-284-5951
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 028075
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | POD000824
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | POD001075
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | POD000686
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License Number State | GA
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