Provider Demographics
NPI:1316625536
Name:SAFE SOURCE DURABLE MEDICAL EQUIPMENT LLC
Entity type:Organization
Organization Name:SAFE SOURCE DURABLE MEDICAL EQUIPMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARA
Authorized Official - Middle Name:LAMAR
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-737-3337
Mailing Address - Street 1:155 WESTRIDGE PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-3050
Mailing Address - Country:US
Mailing Address - Phone:770-278-9313
Mailing Address - Fax:770-888-9759
Practice Address - Street 1:155 WESTRIDGE PKWY STE 201
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-3050
Practice Address - Country:US
Practice Address - Phone:770-278-9313
Practice Address - Fax:770-888-9759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-07
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies