Healthcare Provider Details

I. General information

NPI: 1487104774
Provider Name (Legal Business Name): FAMILY HOME MEDICAL EQUIPMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2016
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 BOULEVARD SQ STE C
WAYCROSS GA
31501-8022
US

IV. Provider business mailing address

1701 BOULEVARD SQ STE C
WAYCROSS GA
31501-8022
US

V. Phone/Fax

Practice location:
  • Phone: 912-590-6546
  • Fax: 912-590-6550
Mailing address:
  • Phone: 912-590-6546
  • Fax: 912-590-6550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SHEILA ROBERSON
Title or Position: COMPLIANCE OFFICER
Credential:
Phone: 480-528-2609