=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972836070
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WOUND HEALING CONSULTANTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2009
-----------------------------------------------------
Last Update Date | 10/29/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4107 HIGH ROCK RD
-----------------------------------------------------
City | GIBSONVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27249-9747
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-706-5190
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4107 HIGH ROCK RD
-----------------------------------------------------
City | GIBSONVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27249-9747
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-706-5190
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | DR. HAROLD A NICHOLS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 336-706-5190
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 22315
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------