Healthcare Provider Details

I. General information

NPI: 1770447799
Provider Name (Legal Business Name): PURDY MEDICAL WIGS & DME SUPPLIER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2025
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 ROCK SPRINGS RD
LITHONIA GA
30038-1504
US

IV. Provider business mailing address

1942 W GRAY ST UNIT 1357
HOUSTON TX
77019-4816
US

V. Phone/Fax

Practice location:
  • Phone: 678-439-8319
  • Fax: 770-200-1620
Mailing address:
  • Phone: 678-439-8319
  • Fax: 770-200-1620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: KAYLA ROSS
Title or Position: OWNER
Credential:
Phone: 678-439-8319