Healthcare Provider Details

I. General information

NPI: 1194000224
Provider Name (Legal Business Name): ACCESS DME FO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2011
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 CRYE LEIKE DR
FORT OGLETHORPE GA
30742-4055
US

IV. Provider business mailing address

4062 HIXSON PIKE
CHATTANOOGA TN
37415-3110
US

V. Phone/Fax

Practice location:
  • Phone: 706-858-6771
  • Fax: 706-858-6772
Mailing address:
  • Phone: 423-877-3568
  • Fax: 423-877-9332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number0000512
License Number StateTN

VIII. Authorized Official

Name: MR. EDDIE JENKINS
Title or Position: MANAGER
Credential:
Phone: 423-877-3568