| NPI | 1578020004 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ETTA STARKS Owner 470-865-2445 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| 332BN1400X Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies | |
| Enumeration Date | 2019-02-20 |
| Last Update Date | 2019-03-01 |