Healthcare Provider Details

I. General information

NPI: 1376200022
Provider Name (Legal Business Name): ELLAM MEDICAL EQUIPMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2021
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 SHANNON HILL RD
RICHMOND VA
23229-4911
US

IV. Provider business mailing address

8201 SHANNON HILL RD
RICHMOND VA
23229-4911
US

V. Phone/Fax

Practice location:
  • Phone: 404-643-5343
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: SHARON W NJUGUNA
Title or Position: OWNER
Credential:
Phone: 404-464-3534