Healthcare Provider Details

I. General information

NPI: 1598353005
Provider Name (Legal Business Name): CALVARY HILL MEDICAL SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2021
Last Update Date: 01/10/2021
Certification Date: 01/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4108 PINE HEIGHTS DR NE
ATLANTA GA
30324-2847
US

IV. Provider business mailing address

4108 PINE HEIGHTS DR NE
ATLANTA GA
30324-2847
US

V. Phone/Fax

Practice location:
  • Phone: 678-860-7876
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name: MS. TANYA TRESTON
Title or Position: VICE PRESIDENT
Credential:
Phone: 678-860-7876