Healthcare Provider Details

I. General information

NPI: 1114108586
Provider Name (Legal Business Name): SAINT SIMMONS SOUND MANAGEMENT COMPANY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 WASHINGTON HIGHWAY
UNION POINT GA
30669
US

IV. Provider business mailing address

1321 WASHINGTON HIGHWAY
UNION POINT GA
30669
US

V. Phone/Fax

Practice location:
  • Phone: 706-486-2167
  • Fax: 706-486-4022
Mailing address:
  • Phone: 706-486-2167
  • Fax: 706-486-4022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number1-066-1880
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number1-066-1880
License Number StateGA

VIII. Authorized Official

Name: BEVERLY BOYER
Title or Position: ADMINISTRATOR
Credential:
Phone: 706-486-2167