Provider Demographics
NPI:1306047162
Name:WALLEN MEDICAL SALES, LLC
Entity type:Organization
Organization Name:WALLEN MEDICAL SALES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-218-2625
Mailing Address - Street 1:5677 BROOKSTONE WALK NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-4581
Mailing Address - Country:US
Mailing Address - Phone:770-218-2625
Mailing Address - Fax:888-597-4366
Practice Address - Street 1:5677 BROOKSTONE WALK NW
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-4581
Practice Address - Country:US
Practice Address - Phone:770-218-2625
Practice Address - Fax:888-597-4366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies