Healthcare Provider Details

I. General information

NPI: 1750878880
Provider Name (Legal Business Name): AJ DME SUPPLIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2018
Last Update Date: 04/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 SARAH DR
ATHENS GA
30606-1674
US

IV. Provider business mailing address

355 SARAH DR
ATHENS GA
30606-1674
US

V. Phone/Fax

Practice location:
  • Phone: 706-424-8173
  • Fax:
Mailing address:
  • Phone: 706-424-8173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. AON WAITE SR.
Title or Position: CO-OWNER
Credential:
Phone: 706-424-8173