NPI Code Detail JSON Logo

1073707436 NPI number — SHILOH WOUND CARE PC

NPI Number: 1073707436
Health Care Provider/Practitioner: SHILOH WOUND CARE PC

Information about “1073707436” NPI (SHILOH WOUND CARE PC) exists in 1073707436 in HTML format HTML  |  1073707436 in plain Text format TXT  |  1073707436 in PDF (Portable Document Format) PDF  |  1073707436 in an XML format XML  formats.

NPI Number : 1073707436 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1073707436",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "SHILOH WOUND CARE PC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3525 PIEDMONT RD NE STE 601",
    "SecondLineMailingAddress": "BLDG. 7",
    "MailingAddressCityName": "ATLANTA",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30305-1578",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "404-842-5423",
    "MailingAddressFaxNumber": "404-848-1229",
    "FirstLinePracticeLocationAddress": "1497 FAIR RD STE 103",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "STATESBORO",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30458-0823",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "912-486-1163",
    "PracticeLocationAddressFaxNumber": "866-795-4593",
    "EnumerationDate": "08/29/2007",
    "LastUpdateDate": "09/01/2010",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "MARTIN",
    "AuthorizedOfficialFirstName": "JOHN",
    "AuthorizedOfficialMiddleName": "E",
    "AuthorizedOfficialTitle": "PRES",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "912-486-1163",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "208600000X",
        "TaxonomyName": "Surgery Physician",
        "LicenseNumber": "025229",
        "LicenseNumberStateCode": "GA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.