Healthcare Provider Details

I. General information

NPI: 1477648186
Provider Name (Legal Business Name): GEORGIA OXYGEN SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 10/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 ROWE ST SUITE D
DUBLIN GA
31021-5200
US

IV. Provider business mailing address

112 ROWE ST SUITE D
DUBLIN GA
31021-5200
US

V. Phone/Fax

Practice location:
  • Phone: 478-272-4797
  • Fax: 478-272-2271
Mailing address:
  • Phone: 478-272-4797
  • Fax: 478-272-2271

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 Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHRE008253
License Number StateGA

VIII. Authorized Official

Name: MR. WILLIAM F. THOMPSON
Title or Position: PRESIDENT
Credential: RRT, CPFT, CRTT
Phone: 478-272-4797