Provider Demographics
NPI:1487767067
Name:SUNSOUTH DIABETIC SOLUTIONS, LLC
Entity type:Organization
Organization Name:SUNSOUTH DIABETIC SOLUTIONS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:KIRK
Authorized Official - Last Name:SHERRILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-560-0178
Mailing Address - Street 1:830 MCGLATHERY LN SE STE A
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-6029
Mailing Address - Country:US
Mailing Address - Phone:256-560-0178
Mailing Address - Fax:256-350-8152
Practice Address - Street 1:830 MCGLATHERY LN SE STE A
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-6029
Practice Address - Country:US
Practice Address - Phone:256-560-0178
Practice Address - Fax:256-350-8152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL112436332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51515338OtherBCBS ALABAMA
AL0132326OtherNCPDP PHARMACY NUMBER
4512440001Medicare NSC