=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073138699
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADL MEDICAL SUPPLY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2020
-----------------------------------------------------
Last Update Date | 05/09/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3595 HIRAM DOUGLASVILLE HWY STE 214
-----------------------------------------------------
City | HIRAM
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30141-4963
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-305-6735
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3595 HIRAM DOUGLASVILLE HWY STE 214
-----------------------------------------------------
City | HIRAM
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30141-4963
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-305-6735
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING DIRECTOR
-----------------------------------------------------
Name | MR. RAMAKRISHNA MACHU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 848-256-0682
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------