Healthcare Provider Details

I. General information

NPI: 1902803000
Provider Name (Legal Business Name): MEDICAL EQUIPMENT SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 DAHLONEGA ST STE 103
CUMMING GA
30040-8212
US

IV. Provider business mailing address

5920 BOULDER BLUFF DR
CUMMING GA
30040-1144
US

V. Phone/Fax

Practice location:
  • Phone: 470-253-8067
  • Fax: 678-807-2998
Mailing address:
  • Phone: 470-249-9869
  • Fax: 678-807-2998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. ERIK JON KOLACINSKI
Title or Position: CEO
Credential:
Phone: 470-249-9869