Provider Demographics
NPI:1124267984
Name:ALTAMAHA DME, INC
Entity type:Organization
Organization Name:ALTAMAHA DME, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:912-427-3726
Mailing Address - Street 1:477 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31545-1130
Mailing Address - Country:US
Mailing Address - Phone:912-427-6600
Mailing Address - Fax:912-427-8003
Practice Address - Street 1:481 ELMA G MILES PKWY STE B
Practice Address - Street 2:SUITE N1
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-4015
Practice Address - Country:US
Practice Address - Phone:912-877-3202
Practice Address - Fax:912-877-3206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-18
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0554860003Medicare NSC
0554830003Medicare NSC
0554830003Medicare PIN