MEDICARE: DIABETIC CARE MANAGEMENT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies		GA

General Provider Information

NPI Number	:	1437460136
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIABETIC CARE MANAGEMENT

Provider Business Mailing Address
First Line	:	PO BOX 6705
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31208-6705
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	219 RIVER HILLS RDG
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31211-6339
Country	:	US
Telephone Number	:	478-256-1597
Fax Number	:

Authorized Official
Title or Position	:	REPRESENTATIVE
Name	:	EVERETT HENDERSON
Credential	:
Telephone Number	:	478-256-1597

Provider Enumeration Date	:	06/28/2010
Last Update Date	:	06/28/2010

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