MEDICARE: COMPASSION WOUND CARE LLC

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	251J00000X	Nursing Care Agency

General Provider Information

NPI Number	:	1073439659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPASSION WOUND CARE LLC

Provider Business Mailing Address
First Line	:	1858 MILLSTREAM HOLW
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30012-3504
Country	:	US
Telephone Number	:	912-220-2838
Fax Number	:

Provider Business Practice Location Address
First Line	:	1858 MILLSTREAM HOLW
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30012-3504
Country	:	US
Telephone Number	:	912-220-2838
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TONIKA PHILLIPS
Credential	:	RN
Telephone Number	:	912-220-2838

Provider Enumeration Date	:	06/26/2026
Last Update Date	:	06/26/2026

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