Healthcare Provider Details

I. General information

NPI: 1639716277
Provider Name (Legal Business Name): USA NETCOM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2019
Last Update Date: 12/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 VILLAGE PARK DR
NEWNAN GA
30265-6259
US

IV. Provider business mailing address

231 VILLAGE PARK DR
NEWNAN GA
30265-6259
US

V. Phone/Fax

Practice location:
  • Phone: 347-209-7384
  • Fax:
Mailing address:
  • Phone: 347-209-7384
  • Fax:

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 Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: CHAYANE COLLADO
Title or Position: OWNER
Credential:
Phone: 347-209-7384