Healthcare Provider Details

I. General information

NPI: 1326041732
Provider Name (Legal Business Name): BACONSFIELD HOMECARE EQUIPMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1042 GRAY HWY
MACON GA
31211-1837
US

IV. Provider business mailing address

1042 GRAY HWY
MACON GA
31211-1837
US

V. Phone/Fax

Practice location:
  • Phone: 478-743-4557
  • Fax: 478-742-4522
Mailing address:
  • Phone: 478-743-4557
  • Fax: 478-742-4522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MISS WENDY M WILLIAMS
Title or Position: GENERAL MANAGER
Credential:
Phone: 478-743-4557