MEDICARE: GLOBAL WOUND CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	028075	GA
2	213E00000X	Podiatrist	POD000824	GA
3	213E00000X	Podiatrist	POD001075	GA
4	213E00000X	Podiatrist	POD000686	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003956210
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLOBAL WOUND CARE

Provider Business Mailing Address
First Line	:	629C RONALD REAGAN DR
Second Line	:
City	:	EVANS
State	:	GA
Zip	:	30809-7607
Country	:	US
Telephone Number	:	706-868-0319
Fax Number	:	706-868-3719

Provider Business Practice Location Address
First Line	:	200 BOND ST
Second Line	:	SUITE 109
City	:	ROYSTON
State	:	GA
Zip	:	30662-4137
Country	:	US
Telephone Number	:	706-245-4040
Fax Number	:	706-245-4070

Authorized Official
Title or Position	:	OWNER / CEO
Name	:	SIVAKUMAR JAYABALAN
Credential	:	PHD. (MBA)
Telephone Number	:	706-284-5951

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	09/06/2013

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Directions to “GLOBAL WOUND CARE ” Practice Location

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