Provider Demographics
NPI:1720809650
Name:UNIVERSAL CONGLOMERATE INC
Entity type:Organization
Organization Name:UNIVERSAL CONGLOMERATE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-702-4983
Mailing Address - Street 1:1144 DRUID PARK AVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-5850
Mailing Address - Country:US
Mailing Address - Phone:678-702-4983
Mailing Address - Fax:
Practice Address - Street 1:1144 DRUID PARK AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-5850
Practice Address - Country:US
Practice Address - Phone:678-702-4983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies