Healthcare Provider Details

I. General information

NPI: 1679745335
Provider Name (Legal Business Name): AMERICAN MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4222 RICKENBACKER DR NE UNIT 8
ATLANTA GA
30342-3768
US

IV. Provider business mailing address

4222 RICKENBACKER DR NE UNIT 8
ATLANTA GA
30342-3768
US

V. Phone/Fax

Practice location:
  • Phone: 404-788-3442
  • Fax: 404-252-2584
Mailing address:
  • Phone: 404-788-3442
  • Fax: 404-252-2584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. JULIUS ANTHONY BOLTON
Title or Position: MANAGING MEMBER
Credential:
Phone: 404-788-3442