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General NPI Number Information
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NPI Number | 1336479849
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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 | 01/05/2010
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Last Update Date | 01/05/2010
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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 | 912-998-0040
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Fax | 912-998-0041
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Provider Business Mailing 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 | 912-998-0040
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Fax | 912-998-0041
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. PAULA KREISSLER
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Credential |
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Telephone | 912-998-0040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 3118839999
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License Number State | GA
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