Healthcare Provider Details

I. General information

NPI: 1841541869
Provider Name (Legal Business Name): JDF CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2012
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 N MAIN AVE
PINE MOUNTAIN GA
31822-2454
US

IV. Provider business mailing address

PO BOX 72148
ALBANY GA
31708-2148
US

V. Phone/Fax

Practice location:
  • Phone: 706-663-2255
  • Fax: 706-663-8026
Mailing address:
  • Phone: 229-435-4571
  • Fax: 229-435-7069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPHRE009870
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberPHRE009870
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberPHRE009870
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE009870
License Number StateGA

VIII. Authorized Official

Name: TRACY C ALLIGOOD
Title or Position: ACCOUNTING MANAGER
Credential:
Phone: 229-435-4571