South Mississippi Wound Management LLC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

SOUTH MISSISSIPPI WOUND MANAGEMENT LLC

Practice address

427 Highway 51 N
Brookhaven, MS 39601-2350

Phone

(601) 835-9444

Fax

(601) 833-5210

NPI assigned

Jul 12, 2021

Organization subpart

No

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

Authorized official

Name

Bradley J Martin, PA

Title

Manager

Phone

(601) 757-6192

Specialties & licenses 1

Addresses

Other names 1

• South Mississippi Wound Management Doing business as

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

{
    "created_epoch": "1626048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626220800000",
    "number": "1366014128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 N STATE ST STE 400",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392021689",
            "telephone_number": "601-944-1717",
            "fax_number": "601-944-9780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "427 HIGHWAY 51 N",
            "city": "BROOKHAVEN",
            "state": "MS",
            "postal_code": "396012350",
            "telephone_number": "601-835-9444",
            "fax_number": "601-833-5210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH MISSISSIPPI WOUND MANAGEMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-12",
        "last_updated": "2021-07-14",
        "certification_date": "2021-07-14",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "601-757-6192",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Mississippi Wound Management",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "South Mississippi Wound Management",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Brookhaven, MS
• Specialist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2021; 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.