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General NPI Number Information
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NPI Number | 1154319408
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Entity Type | Organization
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Legal Business Name | WOUND CARE CLINIC - ESU, INC.
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Dates
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Enumeration Date | 10/11/2005
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Last Update Date | 02/16/2012
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Provider Practice Location Address
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Address Line | 1000 TOWNE CENTER BLVD SUITE 705
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City | POOLER
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State | GA
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Zip | 31322-4052
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Country | US
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Telephone | 912-272-9494
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Fax | 912-998-0041
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Provider Business Mailing Address
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Address Line | PO BOX 9910
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City | SAVANNAH
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State | GA
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Zip | 31412-0110
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Country | US
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Telephone | 912-272-9494
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Fax | 912-998-0041
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | PAULA KREISSLER
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Credential |
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Telephone | 912-272-9494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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