Healthcare Provider Details

I. General information

NPI: 1578512158
Provider Name (Legal Business Name): ATLAS MEDICAL SUPPLY AND EQUIPMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 CENTRAL AVE
CHARLOTTE NC
28205-5207
US

IV. Provider business mailing address

2315 CENTRAL AVE
CHARLOTTE NC
28205-5207
US

V. Phone/Fax

Practice location:
  • Phone: 704-375-3966
  • Fax: 704-375-3964
Mailing address:
  • Phone: 704-375-3966
  • Fax: 704-375-3964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License NumberNONE
License Number StateNC

VIII. Authorized Official

Name: EMILY 1 JOHNS
Title or Position: ONWER
Credential:
Phone: 704-375-3966