1801957964 NPI number — GEORGIA MEDICAL SUPPLY OF RICHLAND , INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801957964 NPI number — GEORGIA MEDICAL SUPPLY OF RICHLAND , INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEORGIA MEDICAL SUPPLY OF RICHLAND , INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801957964
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 550309
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35255-0309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-566-1674
Provider Business Mailing Address Fax Number:
205-278-6900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4454 WARM SPRINGS RD STE D3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31909-5992
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-887-0039
Provider Business Practice Location Address Fax Number:
229-887-0040
Provider Enumeration Date:
12/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DORCEY
Authorized Official First Name:
LONNIE
Authorized Official Middle Name:
BLAKE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
205-566-1674

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000713732A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009702530 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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