Provider Demographics
NPI:1154961472
Name:ZION MEDICAL SUPPLY, INC.
Entity type:Organization
Organization Name:ZION MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:
Authorized Official - Last Name:UZEBU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-274-3433
Mailing Address - Street 1:1572 HIGHWAY 85 N STE 315
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7727
Mailing Address - Country:US
Mailing Address - Phone:770-274-3433
Mailing Address - Fax:
Practice Address - Street 1:1572 HIGHWAY 85 N STE 315
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7727
Practice Address - Country:US
Practice Address - Phone:770-274-3433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-14
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADMEHS1572OtherDMEHS