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General NPI Number Information
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NPI Number | 1104009802
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Entity Type | Organization
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Legal Business Name | AGAPE MEDICAL SUPPLY & DURABLE MEDICAL EQUIPMENT
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Dates
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Enumeration Date | 12/17/2007
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Last Update Date | 12/17/2007
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Provider Practice Location Address
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Address Line | 2564 PEYTON WOODS TRL SW
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City | ATLANTA
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State | GA
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Zip | 30311-2157
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Country | US
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Telephone | 404-696-9826
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Fax | 404-696-9826
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Provider Business Mailing Address
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Address Line | 8202 LULLWATER CT
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City | JONESBORO
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State | GA
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Zip | 30236-3963
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Country | US
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Telephone | 404-435-5931
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Fax | 404-696-9826
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Authorized Official
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Title or Position | DIRECTOR OF BUSINESS DEVELOPMENT
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Name | MR. RONALD WYNN
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Credential |
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Telephone | 404-310-0803
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number |
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License Number State | GA
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