Wound Care Clinic Sd INC
Nurse Practitioner in Jackson, TN. Organization (NPI-2).
NPI number1477529964
StatusActive
Last updated in NPPESAug 22, 2020
Details
- NPI
- 1477529964
- Entity type
- Organization (NPI-2)
- Legal business name
- Wound Care Clinic Sd INC
- Organization subpart
- No
- Enumeration date
- Feb 24, 2006
- Last updated
- Aug 22, 2020
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363L00000X | Nurse Practitioner | – | – | Yes |
Practice location
250 N ParkwayJackson, TN 38305-2735
Phone 731-664-8400 · Fax 731-664-8430
Mailing address
250 N ParkwayJackson, TN 38305-2742
Phone 731-664-8400 · Fax 731-664-8430
Authorized official
Susan G Davis
Owner
7316648400
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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