Organization
PREMIUM HEALTHCARE LLC
Active
Other names
Personic Wound Care of NV
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL SONG MD (OWNER)
(251) 901-3011
Entity
Organization
Contact information
Practice address
8000 TOWERS CRESCENT DR STE 1392, VIENNA, VA 22182-6207
(251) 901-3011
Mailing address
11340 LAKEFIELD DR STE 200, JOHNS CREEK, GA 30097-2456
(251) 901-3011
Taxonomy
Speciality
Code
Description
License number
State
163WW0000X
Wound Care Registered Nurse
Primary
—
—
Other
Enumeration date
08/16/2021
Last updated
09/18/2024
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