MEDICARE: COMPLETE MEDICAL SUPPLY&EQUIPMENT;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	20100038403	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588664601
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPLETE MEDICAL SUPPLY&EQUIPMENT;LLC

Provider Business Mailing Address
First Line	:	PO BOX 1333
Second Line	:
City	:	LITHIA SPRINGS
State	:	GA
Zip	:	30122-1166
Country	:	US
Telephone Number	:	678-213-1055
Fax Number	:	678-213-1056

Provider Business Practice Location Address
First Line	:	6116 MABLETON PKWY SW STE 128
Second Line	:
City	:	MABLETON
State	:	GA
Zip	:	30126-4305
Country	:	US
Telephone Number	:	678-213-1055
Fax Number	:	678-213-1056

Authorized Official
Title or Position	:	MANAGER
Name	:	BASSEY UDOM
Credential	:
Telephone Number	:	678-213-1055

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	11/09/2023

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Directions to “COMPLETE MEDICAL SUPPLY&EQUIPMENT;LLC ” Practice Location

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