Healthcare Provider Details

I. General information

NPI: 1942523717
Provider Name (Legal Business Name): SHUMAN HEALTHCARE OF HOMERVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2010
Last Update Date: 07/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 S CHURCH ST
HOMERVILLE GA
31634-3019
US

IV. Provider business mailing address

625 S CHURCH ST
HOMERVILLE GA
31634-3019
US

V. Phone/Fax

Practice location:
  • Phone: 912-487-0014
  • Fax:
Mailing address:
  • Phone: 912-487-0014
  • Fax:

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 Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: BUCKY P GOBLE
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 912-285-5272