| NPI | 1912519505 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA FROMKIN Credentialing Manager 706-570-0220 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2020-08-17 |
| Last Update Date | 2020-08-17 |