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General NPI Number Information
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NPI Number | 1316778863
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Entity Type | Organization
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Legal Business Name | MEDPRO WOUND CARE SERVICES LLC
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Dates
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Enumeration Date | 08/07/2024
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Last Update Date | 07/15/2025
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Provider Practice Location Address
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Address Line | 432 HIGHGATE PL
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-9440
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Country | US
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Telephone | 833-796-7770
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Fax | 800-504-1362
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Provider Business Mailing Address
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Address Line | 432 HIGHGATE PL
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-9440
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Country | US
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Telephone | 833-796-7770
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Fax | 800-504-1362
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Authorized Official
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Title or Position | CFO/OWNER
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Name | MRS. ANGELA THOMAS HOWARD
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Credential |
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Telephone | 404-488-9839
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #4
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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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