=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750434452
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EAMC THE WOUND TREATMENT CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2000 PEPPERELL PKWY
-----------------------------------------------------
City | OPELIKA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36801-5452
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-528-2319
-----------------------------------------------------
Fax | 334-528-2320
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2000 PEPPERELL PKWY
-----------------------------------------------------
City | OPELIKA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36801-5452
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-528-2319
-----------------------------------------------------
Fax | 334-528-2320
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR - ONCOLOGY SVC & WOUND CTR
-----------------------------------------------------
Name | MR. CHRISTOPHER M CLARK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 334-528-2309
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2083P0011X
-----------------------------------------------------
Taxonomy Name | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------