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General NPI Number Information
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NPI Number | 1689569303
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Entity Type | Organization
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Legal Business Name | PREMIUM WOUND CARE PROS INC
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Dates
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Enumeration Date | 06/11/2025
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 1588 ATKINSON RD
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-7963
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Country | US
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Telephone | 404-545-6888
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Fax |
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Provider Business Mailing Address
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Address Line | 2231 HUNTERS GREEN DR
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-5182
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Country | US
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Telephone | 404-545-6888
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. GIANINA WALKER
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Credential |
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Telephone | 404-545-6888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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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 | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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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 | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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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 | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number |
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License Number State |
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