Healthcare Provider Details

I. General information

NPI: 1437077757
Provider Name (Legal Business Name): FIRST CHOICE MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4480 RIVERSIDE DR STE 19
MACON GA
31210-1363
US

IV. Provider business mailing address

4480 RIVERSIDE DR STE 19
MACON GA
31210-1363
US

V. Phone/Fax

Practice location:
  • Phone: 229-795-1573
  • Fax: 866-706-6026
Mailing address:
  • Phone: 229-795-1573
  • Fax: 866-706-6026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. CANARVIS BRANTLEY
Title or Position: MANAGER
Credential:
Phone: 229-795-1573