Healthcare Provider Details

I. General information

NPI: 1164754446
Provider Name (Legal Business Name): ALTAMAHA DME, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2010
Last Update Date: 01/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 ALTAMA AVE
BRUNSWICK GA
31520-4607
US

IV. Provider business mailing address

477 S 1ST ST
JESUP GA
31545-1130
US

V. Phone/Fax

Practice location:
  • Phone: 912-265-7500
  • Fax: 912-265-7510
Mailing address:
  • Phone: 912-427-6600
  • Fax: 912-427-8003

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 Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number004501
License Number StateGA

VIII. Authorized Official

Name: MRS. TERRI L BRAKE
Title or Position: PRESIDENT
Credential:
Phone: 912-427-6600