MEDICARE: THE DEGRINE GROUP, LLC

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	142533	GA

General Provider Information

NPI Number	:	1578894143
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE DEGRINE GROUP, LLC

Provider Business Mailing Address
First Line	:	860 JOHNSON FERRY RD NE STE 140-153
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1435
Country	:	US
Telephone Number	:	865-406-5578
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 AUBURN AVE NE STE 102
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30303-2612
Country	:	US
Telephone Number	:	865-406-5578
Fax Number	:

Authorized Official
Title or Position	:	PRINCIPAL/OWNER/CEO
Name	:	MR. PERRY GREEN II
Credential	:	MBA, MPHA, MPH
Telephone Number	:	865-406-5578

Provider Enumeration Date	:	01/21/2010
Last Update Date	:	04/21/2010

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