Healthcare Provider Details

I. General information

NPI: 1437013174
Provider Name (Legal Business Name): PRISM DISTRIBUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1396 BRAMLETT FOREST CT
LAWRENCEVILLE GA
30045-2687
US

IV. Provider business mailing address

1396 BRAMLETT FOREST CT
LAWRENCEVILLE GA
30045-2687
US

V. Phone/Fax

Practice location:
  • Phone: 346-466-5298
  • Fax:
Mailing address:
  • Phone: 346-466-5298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. SHAHBAZ ASLAM
Title or Position: OWNER
Credential:
Phone: 346-466-5298