| NPI | 1720262363 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENATA JOHNSON Authorized Official 678-779-9061 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition |
| Enumeration Date | 2007-12-18 |
| Last Update Date | 2007-12-18 |