Provider Demographics
NPI:1811147044
Name:SAMARITAN MEDICAL SUPPLIES LLC.
Entity type:Organization
Organization Name:SAMARITAN MEDICAL SUPPLIES LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADEJOKE
Authorized Official - Middle Name:MARIAN
Authorized Official - Last Name:OGUNNOIKI
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:678-768-3000
Mailing Address - Street 1:3518 ROLLING HILLS DR
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-7438
Mailing Address - Country:US
Mailing Address - Phone:678-768-3000
Mailing Address - Fax:186-641-5909
Practice Address - Street 1:3518 ROLLING HILLS DR
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-7438
Practice Address - Country:US
Practice Address - Phone:678-768-3000
Practice Address - Fax:186-641-5909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA08072753332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies