Healthcare Provider Details

I. General information

NPI: 1720651441
Provider Name (Legal Business Name): MRC PRODUCTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5288 SANDY LK E
LITHONIA GA
30038-3958
US

IV. Provider business mailing address

5288 SANDY LK E
LITHONIA GA
30038-3958
US

V. Phone/Fax

Practice location:
  • Phone: 404-218-2508
  • Fax:
Mailing address:
  • Phone: 404-218-2508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. VINCENT BURTON
Title or Position: CREDENTIAL AGENT
Credential:
Phone: 501-339-7165