Healthcare Provider Details

I. General information

NPI: 1568045334
Provider Name (Legal Business Name): SHAYWAY'S VALUE SHOPPE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 04/30/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2570 BEDFORD PLACE
MACON GA
31211-3121
US

IV. Provider business mailing address

730 PEACHTREE ST NE STE 570
ATLANTA GA
30308-1244
US

V. Phone/Fax

Practice location:
  • Phone: 404-664-6475
  • Fax:
Mailing address:
  • Phone: 404-664-6475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. TIMOTHY SHAY PRESLEY
Title or Position: CEO
Credential:
Phone: 404-664-6475