| NPI | 1689679284 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAM P MORELAND Contract Manager 678-802-2517 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: GA 9801558) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: GA 9801558) |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2020-08-22 |