Healthcare Provider Details

I. General information

NPI: 1629076062
Provider Name (Legal Business Name): PAL HOME DIAGNOSTICS & RESP.CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 02/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 D HILLCREST PKWY
DUBLIN GA
31021-3555
US

IV. Provider business mailing address

1115 D HILLCREST PKWY
DUBLIN GA
31021-3555
US

V. Phone/Fax

Practice location:
  • Phone: 478-274-1653
  • Fax: 478-274-0895
Mailing address:
  • Phone: 478-274-1653
  • Fax: 478-274-0895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number0503093
License Number StateGA

VIII. Authorized Official

Name: PATRICIA A LOWERY
Title or Position: PRESIDENT
Credential: NDT CRTT
Phone: 478-274-1653