Provider Demographics
NPI:1104573625
Name:MABRY MEDICAL SERVICES, LLC
Entity type:Organization
Organization Name:MABRY MEDICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:MABRY
Authorized Official - Suffix:
Authorized Official - Credentials:RMA, PCT, AST, MSHS
Authorized Official - Phone:678-471-6983
Mailing Address - Street 1:4929 N MAIN ST STE 206
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-5323
Mailing Address - Country:US
Mailing Address - Phone:678-471-6983
Mailing Address - Fax:678-403-2310
Practice Address - Street 1:4929 N MAIN ST STE 206
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-5323
Practice Address - Country:US
Practice Address - Phone:678-471-6983
Practice Address - Fax:678-403-2310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-04
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No174200000XOther Service ProvidersMeals
No251B00000XAgenciesCase Management
No253Z00000XAgenciesIn Home Supportive Care
No347C00000XTransportation ServicesPrivate Vehicle