Organization Active NPI

Dynamic Wound Care of Georgia, LLC

  • General Practice Physician
  • Jonesboro, GA
National Provider Identifier
1063385193
Registry record updated Sep 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
DYNAMIC WOUND CARE OF GEORGIA, LLC
Practice address
238 Stockbridge Rd Ste 104
Jonesboro, GA 30236-3629
Phone
(305) 901-5055
NPI assigned
Sep 25, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kirill Filatov
Title
Cfo
Phone
(305) 901-5055

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

238 Stockbridge Rd Ste 104
Jonesboro, GA 30236-3629

Mailing address

238 Stockbridge Rd Ste 104
Jonesboro, GA 30236-3629
Phone (305) 901-5055

National Provider Directory

National Provider Directory

Locations

238 Stockbridge Rd
Ste 104
Jonesboro, GA 30236
Phone (305) 901-5055

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1758758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758758400000",
    "number": "1063385193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "238 STOCKBRIDGE RD STE 104",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302363629",
            "telephone_number": "305-901-5055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "238 STOCKBRIDGE RD STE 104",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302363629",
            "telephone_number": "305-901-5055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC WOUND CARE OF GEORGIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-09-25",
        "last_updated": "2025-09-25",
        "certification_date": "2025-09-25",
        "status": "A",
        "authorized_official_last_name": "FILATOV",
        "authorized_official_first_name": "KIRILL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "305-901-5055"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jonesboro, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.