MEDICARE: WOUND MANAGEMENT SPECIALISTS TN PLLC

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	363L00000X	Nurse Practitioner
2	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1588394100
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOUND MANAGEMENT SPECIALISTS TN PLLC

Provider Business Mailing Address
First Line	:	778 LIBERTY RD
Second Line	:
City	:	FLOWOOD
State	:	MS
Zip	:	39232-9321
Country	:	US
Telephone Number	:	769-243-6141
Fax Number	:	601-510-1665

Provider Business Practice Location Address
First Line	:	6584 POPLAR AVE STE 212
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38138-3687
Country	:	US
Telephone Number	:	769-239-3792
Fax Number	:

Authorized Official
Title or Position	:	CHIEF HUMAN RESOURCE OFFICER
Name	:	LACHELLE GRIFFIN
Credential	:
Telephone Number	:	769-208-4437

Provider Enumeration Date	:	06/15/2022
Last Update Date	:	05/29/2025

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