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General NPI Number Information
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NPI Number | 1326526690
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Entity Type | Organization
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Legal Business Name | KINGDOMWAY MEDICAL INC.
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Dates
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Enumeration Date | 07/30/2018
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Last Update Date | 03/11/2019
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Provider Practice Location Address
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Address Line | 101 TIVOLI GARDENS RD STE C
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-1528
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Country | US
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Telephone | 770-742-0436
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Fax | 770-742-0356
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Provider Business Mailing Address
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Address Line | PO BOX 3051
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-7051
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | HAZEL L SEAY
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Credential |
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Telephone | 770-742-0436
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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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