MEDICARE: SAMARITAN MEDICAL SUPPLIES 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	08072753	GA

General Provider Information

NPI Number	:	1811147044
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMARITAN MEDICAL SUPPLIES LLC.

Provider Business Mailing Address
First Line	:	3518 ROLLING HILLS DR
Second Line	:
City	:	SUWANEE
State	:	GA
Zip	:	30024-7438
Country	:	US
Telephone Number	:	678-768-3000
Fax Number	:	186-641-5909

Provider Business Practice Location Address
First Line	:	3518 ROLLING HILLS DR
Second Line	:
City	:	SUWANEE
State	:	GA
Zip	:	30024-7438
Country	:	US
Telephone Number	:	678-768-3000
Fax Number	:	186-641-5909

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. ADEJOKE MARIAN OGUNNOIKI
Credential	:	LPN
Telephone Number	:	678-768-3000

Provider Enumeration Date	:	09/24/2008
Last Update Date	:	09/24/2008

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