Healthcare Provider Details

I. General information

NPI: 1669485942
Provider Name (Legal Business Name): SRG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 BAY CREEK RD
LOGANVILLE GA
30052-7398
US

IV. Provider business mailing address

78 BAY CREEK RD
LOGANVILLE GA
30052-7398
US

V. Phone/Fax

Practice location:
  • Phone: 770-554-5033
  • Fax: 770-554-5944
Mailing address:
  • Phone: 770-554-5033
  • Fax: 770-554-5944

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: MS. STACY RENEE GREEN
Title or Position: PRESIDENT
Credential:
Phone: 770-554-5033