Healthcare Provider Details

I. General information

NPI: 1316884489
Provider Name (Legal Business Name): MAURICE MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 MAIN ST STE 13
PORTERDALE GA
30014-3438
US

IV. Provider business mailing address

2104 MAIN ST STE 13
PORTERDALE GA
30014-3438
US

V. Phone/Fax

Practice location:
  • Phone: 678-972-6944
  • Fax:
Mailing address:
  • Phone: 678-972-6944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL ALLEN JR.
Title or Position: OWNER
Credential:
Phone: 678-521-8245