Provider Demographics
NPI:1972984813
Name:SCOOTER REPAIR CENTER PLUS
Entity type:Organization
Organization Name:SCOOTER REPAIR CENTER PLUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVENPORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-612-9856
Mailing Address - Street 1:4719 ATLANTA HWY
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-0716
Mailing Address - Country:US
Mailing Address - Phone:770-985-6985
Mailing Address - Fax:770-585-2635
Practice Address - Street 1:4719 ATLANTA HWY
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-0716
Practice Address - Country:US
Practice Address - Phone:770-985-6985
Practice Address - Fax:770-585-2635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA4569332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies