Healthcare Provider Details

I. General information

NPI: 1609799121
Provider Name (Legal Business Name): MINT MEDICAL SUPPLIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2026
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 BAUMGARD WAY
LOCUST GROVE GA
30248-4473
US

IV. Provider business mailing address

220 BAUMGARD WAY
LOCUST GROVE GA
30248-4473
US

V. Phone/Fax

Practice location:
  • Phone: 678-365-1379
  • Fax:
Mailing address:
  • Phone: 678-365-1379
  • Fax:

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: DR. WILLIAM OLIVER HANSFORD
Title or Position: OWNER
Credential:
Phone: 678-365-1379