Provider Demographics
NPI:1578259016
Name:WHOLLY WOUNDS, PLLC
Entity type:Organization
Organization Name:WHOLLY WOUNDS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:SALLIS
Authorized Official - Last Name:MURRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-450-7470
Mailing Address - Street 1:PO BOX 771684
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38177-1684
Mailing Address - Country:US
Mailing Address - Phone:901-450-7470
Mailing Address - Fax:901-881-5944
Practice Address - Street 1:521 ERIN DR UNIT 771684
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4249
Practice Address - Country:US
Practice Address - Phone:901-450-7470
Practice Address - Fax:901-881-5944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-17
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1477964039Medicaid