Provider Demographics
NPI:1922849108
Name:ADVANCED WOUND SOLUTIONS OF GA LLC
Entity type:Organization
Organization Name:ADVANCED WOUND SOLUTIONS OF GA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-422-8172
Mailing Address - Street 1:8735 DUNWOODY PL STE 6
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-2995
Mailing Address - Country:US
Mailing Address - Phone:214-422-8172
Mailing Address - Fax:
Practice Address - Street 1:8735 DUNWOODY PL STE 6
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-2995
Practice Address - Country:US
Practice Address - Phone:214-422-8172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty