Healthcare Provider Details

I. General information

NPI: 1578499794
Provider Name (Legal Business Name): GATEWAY MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2470 WINDY HILL RD SE STE 129
MARIETTA GA
30067-8628
US

IV. Provider business mailing address

2470 WINDY HILL RD SE STE 129
MARIETTA GA
30067-8628
US

V. Phone/Fax

Practice location:
  • Phone: 404-882-3109
  • Fax:
Mailing address:
  • Phone: 404-882-3109
  • Fax:

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: SARA CONARD
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 404-882-3109