Southeastern Wound Care Services, Inc

Primary specialty

Undersea and Hyperbaric Medicine (Emergency Medicine) PhysicianTaxonomy code 207PE0005X

License

59757 Issued in GA

Legal business name

SOUTHEASTERN WOUND CARE SERVICES, INC

Practice address

1412 Milstead Ave NE
Rockdale Medical Center
Conyers, GA 30012-3877

Phone

(678) 413-7738

Fax

(678) 413-7739

NPI assigned

Oct 5, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Sid M Shah, M.D.

Title

President

Phone

(404) 444-1293

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Rosina Ibeth Ellington, ARNP

  • Nurse Practitioner
  • Fayetteville, GA
  • NPI 1184873549
  NPD (past)

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

{
    "created_epoch": "1191542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1253232000000",
    "number": "1710175500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1805 GALILEE CT",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300847405",
            "telephone_number": "404-444-1293",
            "fax_number": "404-601-6880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1412 MILSTEAD AVE NE",
            "address_2": "ROCKDALE MEDICAL CENTER",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300123877",
            "telephone_number": "678-413-7738",
            "fax_number": "678-413-7739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN WOUND CARE SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-05",
        "last_updated": "2009-09-18",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "SID",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "404-444-1293",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207PE0005X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Emergency Medicine, Undersea and Hyperbaric Medicine",
            "state": "GA",
            "license": "59757",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Undersea and Hyperbaric Medicine (Emergency Medicine) Physician in Conyers, GA
• Providers in Conyers, GA by specialty
• Undersea and Hyperbaric Medicine (Emergency Medicine) Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2009; 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.