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General NPI Number Information
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NPI Number | 1164770673
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Entity Type | Organization
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Legal Business Name | ADVANTRRA MEDICAL SUPPLIES
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Dates
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Enumeration Date | 08/15/2012
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Last Update Date | 08/23/2012
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Provider Practice Location Address
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Address Line | 4707 ASHFORD DUNWOODY RD UNIT 467021
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City | ATLANTA
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State | GA
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Zip | 31146-0100
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Country | US
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Telephone | 216-214-1547
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Fax |
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Provider Business Mailing Address
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Address Line | 3665 HOSPITAL AVE
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City | CHAMBLEE
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State | GA
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Zip | 30341
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Country | US
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Telephone | 216-214-1547
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Fax |
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Authorized Official
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Title or Position | V.PRESIDENT
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Name | MR. JAMIE REID
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Credential |
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Telephone | 216-214-1547
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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