Healthcare Provider Details

I. General information

NPI: 1508556713
Provider Name (Legal Business Name): ACWORTH DURABLE MEDICAL EQUIPMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4929 N MAIN ST STE 206
ACWORTH GA
30101-5323
US

IV. Provider business mailing address

4929 N MAIN ST STE 206
ACWORTH GA
30101-5323
US

V. Phone/Fax

Practice location:
  • Phone: 470-416-4920
  • Fax:
Mailing address:
  • Phone: 470-416-4920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. LORI ALEXANDER MABRY
Title or Position: OWNER/CEO
Credential: DHSC
Phone: 678-471-6983