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General NPI Number Information
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NPI Number | 1639033780
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Entity Type | Organization
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Legal Business Name | SC WOUND SOLUTIONS LLC
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Dates
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Enumeration Date | 12/12/2025
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 6020 JIBE CT
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City | AWENDAW
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State | SC
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Zip | 29429-6320
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Country | US
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Telephone | 843-697-5727
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Fax |
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Provider Business Mailing Address
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Address Line | 6020 JIBE CT
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City | AWENDAW
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State | SC
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Zip | 29429-6320
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Country | US
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Telephone | 843-697-5727
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | AMANDA LARSON
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Credential | MD/CEO
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Telephone | 843-697-5727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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