Healthcare Provider Details

I. General information

NPI: 1215584248
Provider Name (Legal Business Name): AMEXSA CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2019
Last Update Date: 08/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2299 SAINT KENNEDY LN
BUFORD GA
30518-7333
US

IV. Provider business mailing address

101 COLONY PARK DR STE 300
CUMMING GA
30040-2751
US

V. Phone/Fax

Practice location:
  • Phone: 404-454-7799
  • Fax:
Mailing address:
  • Phone: 404-454-7799
  • Fax:

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 Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335G00000X
TaxonomyMedical Foods Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. STRAIDER BELLIER
Title or Position: PRESIDENT
Credential:
Phone: 404-454-7799