Healthcare Provider Details

I. General information

NPI: 1407900509
Provider Name (Legal Business Name): HOMETOWN MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 06/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 W LAMAR ST
AMERICUS GA
31709-3544
US

IV. Provider business mailing address

205 W LAMAR ST
AMERICUS GA
31709-3544
US

V. Phone/Fax

Practice location:
  • Phone: 229-924-5225
  • Fax: 229-924-5006
Mailing address:
  • Phone: 229-924-5225
  • Fax: 229-924-5006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MRS. DORIS MARIE MALCOM
Title or Position: PRESIDENT
Credential:
Phone: 229-924-5225