Provider Demographics
NPI:1366549214
Name:ALPHA MEDICAL EQUIPMENT & SUPPLIES, INC
Entity type:Organization
Organization Name:ALPHA MEDICAL EQUIPMENT & SUPPLIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:ASIKA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:404-373-8160
Mailing Address - Street 1:1652 CHURCH STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-5952
Mailing Address - Country:US
Mailing Address - Phone:404-373-8160
Mailing Address - Fax:404-373-8163
Practice Address - Street 1:1524 CHURCH ST
Practice Address - Street 2:SUITE E
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-6500
Practice Address - Country:US
Practice Address - Phone:404-373-8160
Practice Address - Fax:404-373-8163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA00172092332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA280651022AMedicaid
GA280651022AMedicaid
GA5473120001Medicare NSC
5473120001Medicare Oscar/Certification