Healthcare Provider Details

I. General information

NPI: 1316633209
Provider Name (Legal Business Name): WYATT'S DME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 09/02/2025
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10677 VETERANS MEMORIAL HWY
LITHIA SPRINGS GA
30122-2062
US

IV. Provider business mailing address

10677 VETERANS MEMORIAL HWY
LITHIA SPRINGS GA
30122-2062
US

V. Phone/Fax

Practice location:
  • Phone: 770-948-8826
  • Fax: 770-948-8653
Mailing address:
  • Phone: 770-741-0712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. BENJAMIN WEAVER
Title or Position: PRESIDENT
Credential:
Phone: 770-741-0712