Healthcare Provider Details

I. General information

NPI: 1609214568
Provider Name (Legal Business Name): MEADOWS HEALTHCARE ALLIANCE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2013
Last Update Date: 05/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 STEPHENSON AVE
SAVANNAH GA
31405-5971
US

IV. Provider business mailing address

709 STEPHENSON AVE
SAVANNAH GA
31405-5971
US

V. Phone/Fax

Practice location:
  • Phone: 912-200-3346
  • Fax: 912-200-3453
Mailing address:
  • Phone: 912-200-3346
  • Fax: 912-200-3453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberGBU20130020
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberGBU20130020
License Number StateGA

VIII. Authorized Official

Name: MR. JOHNNY CARROLL
Title or Position: DIRECTOR OF OPERATION AND MARKETING
Credential:
Phone: 912-537-6930