MEDICARE: ADVANCED PRO 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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1437942786
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED PRO WOUND CARE LLC

Provider Business Mailing Address
First Line	:	6575 SPRING ST
Second Line	:
City	:	DOUGLASVILLE
State	:	GA
Zip	:	30134-1890
Country	:	US
Telephone Number	:	678-549-2323
Fax Number	:	404-609-1268

Provider Business Practice Location Address
First Line	:	6575 SPRING ST
Second Line	:
City	:	DOUGLASVILLE
State	:	GA
Zip	:	30134-1890
Country	:	US
Telephone Number	:	678-549-2323
Fax Number	:	404-609-1268

Authorized Official
Title or Position	:	OWNER
Name	:	KAY Y JOHNSON
Credential	:	NP
Telephone Number	:	123-456-7890

Provider Enumeration Date	:	05/28/2025
Last Update Date	:	01/07/2026

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