Healthcare Provider Details

I. General information

NPI: 1003826587
Provider Name (Legal Business Name): HI-TECH HEALTHCARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 HIGHWAY 54 W SUITE 1
FAYETTEVILLE GA
30214-4542
US

IV. Provider business mailing address

1805 SHACKLEFORD CT SUITE 100
NORCROSS GA
30093-2924
US

V. Phone/Fax

Practice location:
  • Phone: 770-460-7744
  • Fax: 770-460-7864
Mailing address:
  • Phone: 770-449-6785
  • Fax: 770-449-0648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. GARY TODD TYSON
Title or Position: PRESIDENT
Credential: BS,RRT
Phone: 770-449-6785