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General NPI Number Information
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NPI Number | 1710790100
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Entity Type | Organization
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Legal Business Name | COLUMBUS DIABETES & WOUND CARE CENTER LLC
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Dates
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Enumeration Date | 01/29/2025
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 2300 MANCHESTER EXPY STE A005
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City | COLUMBUS
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State | GA
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Zip | 31904-6805
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Country | US
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Telephone | 337-315-7927
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Fax |
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Provider Business Mailing Address
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Address Line | 2300 MANCHESTER EXPY STE A005
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City | COLUMBUS
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State | GA
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Zip | 31904-6805
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Country | US
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Telephone | 337-315-7927
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | TYLER STOUT
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Credential |
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Telephone | 337-315-7927
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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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 | 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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