MEDICARE: LIFE MEDICAL SUPPLY, 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

General Provider Information

NPI Number	:	1972960995
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE MEDICAL SUPPLY, LLC

Provider Business Mailing Address
First Line	:	2140 MCGEE RD
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-2980
Country	:	US
Telephone Number	:	770-855-9182
Fax Number	:

Provider Business Practice Location Address
First Line	:	2140 MCGEE RD
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-2980
Country	:	US
Telephone Number	:	770-855-9182
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GERALD J. SHELTON
Credential	:
Telephone Number	:	770-885-9182

Provider Enumeration Date	:	01/21/2016
Last Update Date	:	01/21/2016

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