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COLUMBUS DIABETES & WOUND CARE CENTER LLC
NPI 1710790100
Surgery in Columbus, GA

Active since January 29, 2025CLIA 11D2345008 · Waiver
2300 MANCHESTER EXPY STE H202, COLUMBUS, GA 31904(706) 257-7680(706) 257-7681 Get Directions Write a Review

NPPES record last updated: August 1, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Aug 1, 2026, Oct 11, 2025, Jun 25, 2025 (3 updates tracked since 2025).

About Columbus Diabetes & Wound Care Center Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

COLUMBUS DIABETES & WOUND CARE CENTER LLC (NPI 1710790100) is a healthcare organization registered as a surgery in Columbus, Georgia and active in the NPI registry since January 2025. The organization holds a CLIA Waiver certificate valid through June 2, 2028 and lists Tyler Stout, Manager, as its authorized official.

NPPES Registry Identity

NPI1710790100
Entity TypeOrganization
Primary Taxonomy208600000X
Legal Business NameCOLUMBUS DIABETES & WOUND CARE CENTER LLC
Location Address2300 MANCHESTER EXPY STE H202Columbus, GA 31904-6803
Mailing Address2300 Manchester Expy Ste H202Columbus, GA 31904-6803 · (706) 257-7680 · Fax (706) 257-7681
Phone(706) 257-7680
Fax(706) 257-7681
Organization SubpartNo
Authorized OfficialTyler StoutManager · (337) 315-7927
Enumeration DateJanuary 29, 2025
Last NPPES UpdateAugust 1, 20263 updates tracked since enumeration
NPPES CertifiedAugust 1, 2026
✔ NPI 1710790100 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtySurgeryAllopathic & Osteopathic Physicians
Taxonomy Code208600000X
Definition
A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.
Also ListedFamily MedicineTaxonomy 207Q00000X
Also ListedNurse PractitionerTaxonomy 363L00000X
Also ListedNurse Practitioner · FamilyTaxonomy 363LF0000X
2300 MANCHESTER EXPY STE H202, Columbus, GA 31904
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Columbus Diabetes & Wound Care Center Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

6

Medicare enrollment records show 6 clinicians reassign Medicare billing to Columbus Diabetes & Wound Care Center LLC, which bills Medicare for the services they deliver. Of these, 4 practice at this address and 5 within 10 miles. They are listed nearest first.

Clinicians, nearest first (6)

Anna Childers, FNP-C
Nurse Practitioner
NPI 1972946523
2300 MANCHESTER EXPY STE H202
Columbus, GA 31904
(706) 257-7680
✔ PECOSSame address
Jahangir Cyrus, M.D.
Endocrinology
NPI 1558306092
2300 MANCHESTER EXPY STE H202
Columbus, GA 31904
(706) 257-7680
✔ PECOSSame address
James Majors, M.D.
General Surgery
NPI 1699875963
2300 MANCHESTER EXPY STE C001
Columbus, GA 31904
(706) 324-3243
✔ PECOS✔ Accepts MedicareSame address
Larhonda Randolph
Nurse Practitioner
NPI 1629890843
2300 MANCHESTER EXPY STE H202
Columbus, GA 31904
(706) 257-7680
✔ PECOS✔ Accepts MedicareSame address
Paige Bence, FNP-BC
Nurse Practitioner
NPI 1457867871
3726 WOODRUFF RD
Columbus, GA 31904
(706) 257-7680
✔ PECOS✔ Accepts Medicare0.4 mi
Victor Knutzen, MD, FACS, FACOG.
Family Practice
NPI 1255679320
313 PILOT RD STE B
Las Vegas, NV 89119
(725) 204-8972
✔ PECOS1,738 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 11D2345008

Columbus Diabetes & Wound Care Center LLC · Columbus, GA
Active · expires Jun 2, 2028
CLIA Number11D2345008
Laboratory TypePhysician Office
Certificate Effective DateJune 3, 2026
Certificate Expiration DateJune 2, 2028
Laboratory DirectorVictor K. Knutzen
Laboratory Phone(706) 257-7680
Laboratory LocationColumbus Diabetes & Wound Care Center LLC2300 Manchester Expressway, Suite A005, Columbus, GA 31904
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Columbus Diabetes & Wound Care Center LLC's NPI number?

The NPI number for Columbus Diabetes & Wound Care Center LLC is 1710790100. It was assigned to this organization in the NPPES registry on January 29, 2025.

Where is Columbus Diabetes & Wound Care Center LLC located?

Columbus Diabetes & Wound Care Center LLC is located at 2300 Manchester Expy Ste H202, Columbus, GA 31904. The listed phone number is (706) 257-7680.

What is Columbus Diabetes & Wound Care Center LLC's specialty?

The primary specialty registered for this NPI is Surgery with taxonomy code 208600000X.

Is Columbus Diabetes & Wound Care Center LLC enrolled in Medicare?

Yes. Columbus Diabetes & Wound Care Center LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Columbus Diabetes & Wound Care Center LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 6 clinicians in 4 Medicare specialties reassign their Medicare billing to Columbus Diabetes & Wound Care Center LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (3), Endocrinology (1) and Family Practice (1). Of these, 4 practice at this address and 5 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Columbus Diabetes & Wound Care Center LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D2345008) is associated with this NPI, valid through June 2, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Columbus Diabetes & Wound Care Center LLC was last updated on August 1, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.