Healthcare Provider Details

I. General information

NPI: 1295023877
Provider Name (Legal Business Name): INMAN ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2011
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 MAIN ST
GEORGETOWN GA
39854-4448
US

IV. Provider business mailing address

223 PEBBLE SHORES DR
GEORGETOWN GA
39854-7015
US

V. Phone/Fax

Practice location:
  • Phone: 229-376-8325
  • Fax:
Mailing address:
  • Phone: 229-376-8325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateGA

VIII. Authorized Official

Name: MR. RANDY SHANE INMAN
Title or Position: OWNER
Credential:
Phone: 229-376-8325