Provider Demographics
NPI:1366749335
Name:CC MEDICAL SUPPLY
Entity type:Organization
Organization Name:CC MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHARIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BATTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-913-6375
Mailing Address - Street 1:6266 WINDY RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-6625
Mailing Address - Country:US
Mailing Address - Phone:678-913-6375
Mailing Address - Fax:
Practice Address - Street 1:111 BOX
Practice Address - Street 2:
Practice Address - City:REDAN
Practice Address - State:GA
Practice Address - Zip Code:30074-0111
Practice Address - Country:US
Practice Address - Phone:770-482-7755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-27
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
No332S00000XSuppliersHearing Aid Equipment