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General NPI Number Information
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NPI Number | 1063231645
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Entity Type | Organization
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Legal Business Name | GEORGIA WOUNDCARE MD LLC
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Dates
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Enumeration Date | 10/09/2024
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Last Update Date | 03/30/2025
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Provider Practice Location Address
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Address Line | 1165 SANDERS RD
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City | CUMMING
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State | GA
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Zip | 30041-5965
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Country | US
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Telephone | 210-379-8553
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Fax |
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Provider Business Mailing Address
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Address Line | 8000 AVALON BLVD STE 100
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City | ALPHARETTA
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State | GA
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Zip | 30009-2469
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Country | US
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Telephone | 210-379-8553
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Fax |
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Authorized Official
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Title or Position | MD/OWNER
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Name | KISHORE RASAMALLU
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Credential | MD
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Telephone | 210-379-8553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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