Healthcare Provider Details

I. General information

NPI: 1821269143
Provider Name (Legal Business Name): DME OF GEORGIA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 03/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1347 HIGHWAY 138 SW
RIVERDALE GA
30296-1403
US

IV. Provider business mailing address

1347 HIGHWAY 138 SW
RIVERDALE GA
30296-1403
US

V. Phone/Fax

Practice location:
  • Phone: 678-489-8133
  • Fax: 678-379-4672
Mailing address:
  • Phone: 678-489-8133
  • Fax: 678-379-4672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. KAVIN K MCGEE
Title or Position: PRESIDENT/CEO
Credential:
Phone: 678-489-8133