Provider Demographics
NPI:1194266247
Name:PRIMARY CARE MEDICAL SUPPLY OF ATLANTA LLC
Entity type:Organization
Organization Name:PRIMARY CARE MEDICAL SUPPLY OF ATLANTA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-881-8010
Mailing Address - Street 1:4760 HAMMERMILL RD STE 205
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-6612
Mailing Address - Country:US
Mailing Address - Phone:770-881-8010
Mailing Address - Fax:770-492-3371
Practice Address - Street 1:4760 HAMMERMILL RD STE 205
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-6612
Practice Address - Country:US
Practice Address - Phone:770-881-8010
Practice Address - Fax:770-492-3371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-08
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies