=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205831765
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GEORGIA MEDICAL EQUIPMENT AND RESPIRATORY SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2005
-----------------------------------------------------
Last Update Date | 07/10/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1891 N COLUMBIA ST STE 109
-----------------------------------------------------
City | MILLEDGEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31061-2368
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-451-5185
-----------------------------------------------------
Fax | 478-451-5187
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 670
-----------------------------------------------------
City | MILLEDGEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31059-0670
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-451-5185
-----------------------------------------------------
Fax | 478-451-5187
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. JEROME H HUELLEMEIER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 478-451-5185
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 332B00000X
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------