Healthcare Provider Details

I. General information

NPI: 1104622687
Provider Name (Legal Business Name): SAPPHIRES HOME MEDICAL SUPPLIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 MILSTEAD RD NE STE 102
CONYERS GA
30012-3824
US

IV. Provider business mailing address

1315 MILSTEAD RD NE STE 102
CONYERS GA
30012-3824
US

V. Phone/Fax

Practice location:
  • Phone: 470-545-0860
  • Fax: 470-300-7778
Mailing address:
  • Phone: 470-217-8445
  • Fax: 470-300-7778

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 Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: ELLA STEPHENSON
Title or Position: ADMINISTRATOR/DON
Credential: RN
Phone: 470-217-8445