Provider Demographics
NPI:1992167316
Name:SOUTHERN MEDICAL SUPPLY OF GEORGIA (LLC)
Entity type:Organization
Organization Name:SOUTHERN MEDICAL SUPPLY OF GEORGIA (LLC)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAYNECIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-369-1009
Mailing Address - Street 1:7183 JONESBORO RD
Mailing Address - Street 2:#100-A
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-2955
Mailing Address - Country:US
Mailing Address - Phone:678-369-1009
Mailing Address - Fax:678-426-6777
Practice Address - Street 1:7183 JONESBORO RD
Practice Address - Street 2:#100-A
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-2955
Practice Address - Country:US
Practice Address - Phone:678-369-1009
Practice Address - Fax:678-426-6777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-24
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies