Provider Demographics
NPI:1306124144
Name:KLEMAKO MEDICAL SUPPLIES INC.
Entity type:Organization
Organization Name:KLEMAKO MEDICAL SUPPLIES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CLEMENT
Authorized Official - Middle Name:
Authorized Official - Last Name:NWANOLUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-222-3332
Mailing Address - Street 1:3875 POWDER SPRINGS RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-2759
Mailing Address - Country:US
Mailing Address - Phone:770-222-3332
Mailing Address - Fax:
Practice Address - Street 1:3875 POWDER SPRINGS RD
Practice Address - Street 2:SUITE D
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-2759
Practice Address - Country:US
Practice Address - Phone:770-222-3332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-27
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8086332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies